Behavioral and Cognitive-Behavioral Approaches to Chronic Pain: Recent Advances and Future Directions

Behavioral and cognitive-behavioral approaches to chronic pain are receiving increasing attention from researchers and clinicians. This article reviews and highlights recent research advances and future research directions. Assessment research reviewed includes studies examining the social context of pain, the relationship of chronic pain to depression, cognitive variables affecting pain, and comprehensive assessment measures. Treatment outcome studies reviewed are those evaluat-ing the effects of behavioral and cognitive-behavioral treatments for chronic pain. These studies focus on comparisons of behavioral treatment with control conditions, comparisons of two behav-ioral treatments, and prevention of chronic pain. Future directions for assessment and treatment research are outlined. Two major approaches to the assessment and treatment of chronic pain have evolved within the field of behavioral medi-cine over the past 15 years (Turner & Clancy, 1988). The first is a behavioral approach based on operant conditioning princi-ples (Fordyce, 1976). This approach is designed to modify mal-adaptive pain behaviors (e.g., excessive dependence on bed rest