Psychotherapy for the Treatment of Acute Musculoskeletal Pain: A Review of Clinical Effectiveness and Guidelines [Internet]

Excerpt

Musculoskeletal pain is characterized by pain commonly affecting the following areas – joints (e.g. arthritic conditions), bones (e.g. osteoporosis, fracture), muscle (e.g. sarcopenia), spine (back and neck pain), and multiple body areas or systems (e.g. lupus). Musculoskeletal pain is generally considered chronic in nature if it persists for more than three months, whereas an accepted definition of acute or subacute pain is less common in the literature. However, short-term (≤ 3 months) pain can be categorized subacute if it lasts for seven to 12 weeks; therefore, pain shorter in duration (≤ 6 weeks) can be considered acute.

Psychological therapies are aimed at influencing the psychosocial processes and are recommended alone or in combination with pharmacologic treatments for the management of pain, disability or related symptoms. Cognitive-behavioral techniques (CBT) is one of the most common type of psychotherapy, consisting of cognitive restructuring, reframing and reappraisal based on the individual needs of patients and their specific situation. Acceptance and commitment therapy (ACT) is a psychological intervention that uses acceptance and mindfulness strategies, in combination with commitment and behavior change strategies, to increase psychological flexibility. Relaxation techniques involve systematically instructing participants in progressive muscle relaxation, relaxing breathing techniques, hypnosis, music therapy, guided imagery, or autogenic training (desensitization-relaxation technique). Finally, mindfulness techniques is characterized by the purposeful and nonjudgmental focus on the present moment, whereby one engages in awareness of bodily sensation, thoughts, or emotion; a practice that is thought to counteract negative emotional states. Examples of mindfulness include deep breathing, sitting meditation, yoga, and a body scan, in which attention is directed throughout different parts of the body.

Psychotherapy for pain management is primarily targeted at improving physical, emotional, social, and occupational functioning rather than resolution of the underlying cause of pain or pain itself. These therapies have variable success in pain management resulting from the differences in their scope, duration, administration process, and goals. The objective of the current report is to evaluate the evidence on the clinical effectiveness of psychological interventions versus other treatments for acute (lasting < 6 weeks) or subacute (lasting ≥ 6 weeks but ≤ 3 months) musculoskeletal pain. Additionally, evidence-based guidelines regarding the use of psychological therapies for the treatment of acute or subacute musculoskeletal pain will be reviewed.