Abstract
Pharmacotherapy is most appropriate in acute pain, whereas in chronic pain states behavioral approaches or a combination of behavioral treatment and pharmacotherapy is more appropriate. In this chapter we first describe the role of learning and memory as well as other psychological factors in the development of chronic pain and emphasize that chronic pain must viewed as the result of a learning process with resulting central neuroplastic changes. We then describe operant behavioral and cognitive-behavioral treatments as well as biofeedback and relaxation techniques and present innovative treatment procedures aimed at altering central pain memories. We complete the section with a discussion of combined behavioral and pharmacological approaches and an interdisciplinary view.
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References
Anand KJ, Coskun V, Thrivikraman KV, Nemeroff CB, Plotsky PM (1999) Long-term behavioral effects of repetitive pain in neonatal rat pups. Physiol Behav 66:627–637
Angst MS, Clark JD (2006) Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology 104:570–587
Bair MJ, Robinson RL, Katon W, Kroenke K (2003) Depression and pain comorbidity: a literature review. Arch Intern Med 163:2433–2434
Buntin-Mushock C, Phillip L, Moriyama K, Palmer PP (2005) Age-dependent opioid escalation in chronic pain patients. Anesth Analg 100:1740–1745
Dinse HR, Ragert P, Pleger B, Schwenkreis P, Tegenthoff M (2003) Pharmacological modulation of perceptual learning and associated cortical reorganization. Science 301:91–94
Flor H, Fydrich T, Turk DC (1992) Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain 49:221–230
Flor H, Elbert T, Wienbruch C, Pantev C, Birbaumer N, Larbig W, Taub E (1995) Phantomlimb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 375:482–484
Flor H, Denke C, Schaefer M, Gruesser S (2001) Effect of sensory discrimination training on cortical reorganisation and phantom limb pain. Lancet 357:1763–1764
Fordyce GL (1976) Behavioral concepts in chronic pain illness. Mosby, St. Louis
Fordyce GL, Shelton JL, Dundore DE (1982) The modification of avoidance learning pain behaviors. J Behav Med 5:405–414
Gentry J, Bernal K (1977) Chronic pain. In: Williams RB, Gentry WD (eds) Behavioral approaches to medical treatment. Ballinger, Cambridge, pp 173–182
Huse E, Preissl H, Larbig W, Birbaumer N (2001) Phantom limb pain. Lancet 358:1015
Lethem J, Slade PD, Troup JD, Bentley G (1983) Outline of a fear-avoidance model of exaggerated pain perception. Behav Res Ther 21:401–408
Lotze M, Grodd W, Birbaumer N, Erb M, Huse E, Flor H (1999) Does use of a myoelectric prosthesis prevent cortical reorganization and phantom limb pain? Nat Neurosci 2:501–502
McCabe CS, Haigh RC, Ring EF, Halligan PW, Wall PD, Blake DR (2003) A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1). Rheumatology 42:97–101
Mogil JS (1999) The genetic mediation of individual differences in sensitivity to pain and its inhibition. Proc Natl Acad Sci U S A 96:7744–7751
Moseley GL (2004) Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain 108:192–198
Ressler KJ, Rothbaum BO, Tannenbaum L, Anderson P, Graap K, Zimand E, Hodges L, Davis M (2004) Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry 61:1136–1144
Thieme K, Gromnica-Ihle E, Flor H (2003) Operant behavioral treatment of fibromyalgia: a controlled study. Arthritis Rheum 49:314–320
Turk DC, Okifuji A (2002) Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol 70:678–690
Turk DC, Meichenbaum DH, Genest M (1983) Pain and behavioral medicine: a cognitive-behavioral perspective. Guilford, New York
Turk DC, Okifuji A, Sinclair JD, Starz TW(1998) Interdisciplinary treatment for fibromyalgia syndrome: clinical and statistical significance. Arthritis Care Res 11:186–195
Vlaeyen JW, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332
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© 2006 Springer-Verlag Berlin Heidelberg
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Flor, H., Diers, M. (2006). Limitations of Pharmacotherapy: Behavioral Approaches to Chronic Pain. In: Stein, C. (eds) Analgesia. Handbook of Experimental Pharmacology, vol 177. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-33823-9_15
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DOI: https://doi.org/10.1007/978-3-540-33823-9_15
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-33822-2
Online ISBN: 978-3-540-33823-9
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