How can psychological therapies be useful in chronic pain and affect medical utilization?
Psychological treatments can reduce the perception of pain intensity, medication use, and pain disability and improve overall functioning. Pain patients experience changes in their autonomy and identity and over time deplete internal and external psychosocial resources. Many life domains (e.g., ability to work, changes in marital and relational roles, sexual functioning) are severely impaired, which further perpetuates chronic strain, emotional pain, and psychiatric distress. Psychological therapies can benefit pain patients by restoring, strengthening, and harnessing their resources, self-image, coping styles, and ability to engage in self-care. Treatments also identify and shape environmental reinforcements of sickness and other maladaptive behaviors, help adjustment and management of pain and stress, construct meaning from the condition and interpretation of pain experience, discriminate between negative affective states and psychical pain, and alleviate emotional distress. All of these can improve emotional functioning. Treatments also promote treatment adherence, foster health lifestyle behaviors, challenge maladaptive patient beliefs about pain and fear-avoidance activity, enhance coping efforts, and increase self-efficacy. Once psychiatric distress has been reduced and positive emotions and adaptive coping strategies are employed, patients may reduce overutilization of health care, decrease medication usage, report reductions in pain and sleep disturbance, become more active, and overall have an improvement in their quality of life.