Dialectical Pain Management: Feasibility of a Hybrid Third-Wave Cognitive Behavioral Therapy Approach for Adults Receiving Opioids for Chronic Pain

Abstract

Objectives This study evaluated the feasibility, acceptability, and potential effectiveness of a hybrid skills-based group intervention, dialectical pain management (DPM), for adults with chronic pain who are receiving long-term opioid therapy. DPM adapts dialectical behavior therapy, a rigorous psychotherapeutic approach to emotion dysregulation, to treat disorders of physiological dysregulation. Methods Individuals with chronic pain (N = 17) participated in one of two 8-week DPM intervention cohorts. At pre-test and post-test, participants completed quantitative self-report assessments measuring pain intensity and interference, depressive symptoms, pain acceptance, beliefs about pain medications, and global rating of change. Within 2 weeks after the intervention, participants completed qualitative interviews to assess participant satisfaction and obtain feedback about specific intervention components. Results Of the 17 enrolled, 15 participants completed the group with 12 (70%) attending six or more sessions. Participants reported high satisfaction with the intervention. Preliminary findings suggested a significant increase in pain acceptance and a significant reduction in depressive symptoms. Participants also reported an improved relationship with their pain conditions and increased flexibility in responding to pain and applying coping skills. Several participants showed a reduction in opioid dosage over the course of the intervention. Discussion Findings support that DPM is a feasible and well-received intervention for individuals with chronic pain. Additional research with a control group is needed to further determine the intervention’s efficacy and impact.

Cognition and Pain: A Review

“…Cognitive behavior therapy refers to the psychotherapeutic techniques used to decrease pain perception. Traditionally, it includes relaxation therapy, activity pacing, sleep hygiene, scheduling pleasant activity, identifying and modifying cognitive distortions (Barrett et al, 2020). CBT has also shown promise in preventing acute pain conversion to chronic pain (Glare et al, 2020).…”

“…Evidence in fibromyalgia patients suggests the clinical benefits of CBT in reducing pain catastrophizing (Lazaridou et al, 2017). Newer CBT methods, such as dialectic pain management (DPM), are being employed to improve and respond to chronic pain therapy (Barrett et al, 2020). DPM skill group sessions include a dialectic integration of change with acceptance to the present moment; this construct is further strengthened with mindfulness practices.…”

“…DPM skill group sessions include a dialectic integration of change with acceptance to the present moment; this construct is further strengthened with mindfulness practices. Emotions, vulnerabilities, self-compassion, motivation, invalidation, and interpersonal effectiveness, and other personal challenges are addressed that commonly impact chronic pain patients (Barrett et al, 2020). Not just chronic pain, but therapies like acupuncture, hypnosis, mindfulness, relaxation, VR, and AR-based delivery system are being utilized for inpatient and outpatient acute pain such as headache, migraine, and pain in acute and emergency setting (Lindner et al, 2020;Vekhter et al, 2020).…”

“…Apart from the psycho-social influences of pain, it can also impact the functional domains and the quality of life in general (Al Mahrouqi et al, 2020). Further, chronic pain's economic impact costs $635 billion annually in direct medical costs, loss of productivity, and disability programs (Barrett et al, 2020). Thus, evaluating the relationship between cognition and pain is critical to understanding chronic pain syndromes, their associations with comorbidities, and their psychosocial impact for ultimately improving therapeutic targets and patient outcomes.…”

Influence of the Cognitive and Emotional Status of Patients with Chronic Pain on Treatment Success (Reduction in Pain Intensity and Adherence to Pharmacotherapy): A Prospective Study

“…Due to the poor emotional state caused by depression and anxiety, we can assume that patients are less likely to follow the physician’s instructions. This could be supported by the literature, which states that, among other aspects, emotions, vulnerability, self-compassion, and motivation commonly impact chronic pain patients [ 49 ]. This anxiety often leads to the avoidance of activities that can exacerbate pain and worsen disability [ 50 ].…”