The efficacy of psychological and pharmacological interventions for the treatment of chronic disease-related and non-disease-related pain

In the present article we selectively review controlled studies of psychological and pharmacological interventions for patients with disease-related and non-disease-related pain. We evaluate these studies in light of the criteria for empirically validated treatments set forth in the American Psychological Associationʹs Division of Clinical Psychology Task Force Report on Promotion and Dissemination of Psychological Procedures (Chambless et al., 1995). This review suggests that psychological and pharmacological interventions have proceeded along two relatively independent lines. Generally, the research indicates that psychological interventions are efficacious across a range of outcome measures and benefits are maintained over 1-year follow-up periods. Research on pharmacological interventions generally indicate that narcotic medications result in better pain control if delivered on fixed internal schedules rather than on an as needed basis. In addition, there is some evidence that antidepressants medications lead to pain reduction for some patients. This review suggest that future research should evaluate the relative efficacy of pharmacological versus psychological versus integrated approaches with more homogenous pain populations. Attention should be given to component analyses, treatment manuals, mechanism of action, cost effectiveness, checks on treatment integrity, and issues of clinical significance. Moreover, future research should focus on individual differences in psychological characteristics that influence response to treatment. Finally, experts in chronic pain need to educate policymakers and primary care providers about the multidimensional nature of chronic pain.