Behavioral Conceptualization and Treatment for Chronic Pain‪.‬

Abstract The current article offers a behavioral conceptualization for clinical pain, reviews the empirical evidence supporting this behavioral model, summarizes evidence-based behavioral treatments for chronic pain and supporting science, outlines treatment application limits, and summarizes research needs. Clinical pain is defined as an interacting cluster of overt, covert, and neurophysiological responses initially produced by relevant tissue damage or irritation, which can be maintain by other antecedent and consequent stimulus conditions through operant, respondent, and observational learning effects. Operant and respondent based treatment methods are reviewed, with existing research strongly supporting their efficacy with chronic low back, myofascial, and headache pain patients. These behavioral methods have limited application, due to insufficient research, when applied to acute or cancer pain states, geriatric pain patients, and to some extent pediatric patients. Research needs include continued empirical investigation of the behavioral conceptualization model presented, empirical demonstration of efficacy with those painful conditions and patient types with insufficient research support, treatment matching studies, comparative efficacy (including cost) studies, and efficacy with combined treatment approaches. It is strongly recommended that continued resource allocation be applied to sustain ongoing scientific efforts necessary to maintain and enhance behavioral approaches for managing clinical pain.