The three treatments that have been studied the most, and have pretty good evidence to support them, are biofeedback, cognitive behavioral treatment, and acceptance and mindfulness-based treatments. We’re starting to think a lot about subgroups of patients that may benefit more from one or another approach.
One of the things that I promote is the early use of these treatments. Traditionally, they are kind of the end-stage, left to the end when everything else has failed. At that point, getting anything to work is really challenging so I advocate the idea that psychological treatment should be considered very early. Even when there’s no access to a specialized mental health provider who has experience working with pain, there are many self-help materials that are out and available both in terms of booklets as well as websites that can promote the person’s self-management of pain.
A lot of what we talk about in the pain field now is a model that is similar to what has evolved in diabetes. That is the idea that diabetes is a 24/7 condition that requires a lot of work on the part of the patients and not just taking medications. That same model is probably a very useful model for people who have chronic pain. Any practitioner should be encouraging their patients to be looking for strategies that they can use on a day-to-day basis to self-manage their pain symptoms.