Exposure Therapy and Counterconditioning Equally Effective for Pain-Related Fear

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Cognitive-behavioral treatments typically target pain-related fear using exposure therapy, the clinical analog of Pavlovian extinction.
Cognitive-behavioral treatments typically target pain-related fear using exposure therapy, the clinical analog of Pavlovian extinction.

Exposure therapy and counterconditioning are equally effective cognitive-behavioral methods of reducing pain-related fear, according to a study published in the Journal of Pain.1  

According to lead author Ann Meulders, PhD, from the University of Leuven in Belgium, the findings are particularly relevant to patients with chronic pain, in whom pain-related fear is often more disabling than pain itself.

“In the case of chronic pain, there is often no bodily injury or medical cause for the pain. Rather, it is sensitization or lack of descending inhibition leading to, [or] inflating, the pain. Emotional states such as fear can also increase pain sensitivity. We believe that targeting this fear, without the promise of pain relief, might counter functional disability,” Dr. Meulders told Clinical Pain Advisor.

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Cognitive-behavioral treatments typically target pain-related fear using exposure therapy, the clinical analog of Pavlovian extinction.

"The feared activity — bending the back to pick something up — is performed without the expected catastrophe to occur, leading to a disconfirmation of this belief,” Dr. Meulders explained.

Although graded exposure in vivo has become standard practice, patients tend to relapse into fear of movement-related pain after time and in certain circumstances, Bob Twillman, PhD, executive director of the American Academy of Pain Management, told Clinical Pain Advisor.

Investigators had initially hypothesized that counterconditioning — the absence of pain, combined with a reward — would yield a more robust and durable effect than exposure therapy.

Although the study findings suggest that neither method is superior to the other, they do provide subtle evidence that a combination approach could produce a more durable response, meaning subjects might be less likely to relapse into fear, Dr. Twillman pointed out.

“For clinicians, this suggests that interventions that encourage a caregiver to participate in activities with the patient — and to provide positive reinforcement for those activities — might be a more effective plan in the long term,” Dr. Twillman suggested.

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