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Critically, in using cognitive‐behavioural methods, the patient is necessarily an active
participant in the process, rather than a passive recipient, as he or she must apply the
methods taught as needed.
Applying pain coping strategies within a cognitive-behavioural
intervention
Generally, while some responses by patients to their pain may be helpful, others may not.
For example, those who respond with overly alarmist (or catastrophic) thoughts tended to
experience more pain and distress, compared with those who did not respond in this way
(eg Jensen et al, 1991; Haythornthwaite et al, 2001 Level II; Sullivan et al, 2001). Identifying unhelpful
responses, whether they are cognitive or behavioural, and changing these responses is a key
feature of cognitive‐behavioural interventions. Thus, identifying and reducing catastrophic
thoughts about pain has become a key intervention within this approach, whether the pain is
acute or persistent (Sullivan et al, 2006). It has also been recognised that a given coping strategy
may not always be useful and that this may depend upon circumstances and timing (Turk &
Monarch, 2002). For example, ignoring or denying the presence of pain may be useful when first
injured (to reduce distress), but if it means that appropriate help is not sought it could place
the person in danger.
In preparation for surgery, painful medical procedures and postsurgical pain and distress,
training in cognitive coping methods and behavioural instructions, in addition to relaxation
training and procedural information, improved pain measures and reduced postoperative use
of analgesics. These interventions were effective in achieving improvements in measures of
negative affect, length of stay (not cognitive methods in this case) and recovery (Johnston &
Vogele, 1993 Level I).
A review of studies (randomised and non‐randomised) using cognitive‐behavioural
interventions in the treatment of procedure‐related pain in children and adolescents
concluded that cognitive‐behavioural interventions may be considered a well‐established
treatment in this setting. Treatments included breathing exercises and other forms of
relaxation and distraction, imagery and other forms of cognitive coping skills, filmed
modelling, reinforcement/incentive, behavioural rehearsal and active coaching by a
psychologist, parents, and /or medical staff member (Powers, 1999 Level IV). CHAPTER 8
Another review included studies (all non‐randomised) that used behavioural interventions
in the care of children and adolescents with cancer pain undergoing a wide range of cancer‐
related diagnostic and treatment procedures including bone marrow aspiration, lumbar
puncture, venipuncture, and chemotherapy. The behavioural interventions included hypnosis,
relaxation, procedural information, distraction techniques, modifications of children’s fears,
anxiety and pain, contingency management, systematic desensitisation and behavioural
rehearsal. Experience of pain during diagnostic and treatment procedures was included as
an outcome measure in nine of the twenty‐three included studies; all nine studies found a
clinically significant reduction in pain following behavioural intervention (DuHamel et al, 1999
Level IV).
A further review examined the effectiveness of behavioural intervention methods in studies
(randomised and non‐randomised) looking at the control of aversive side effects of cancer
treatment, including pain (Redd et al, 2001 Level IV). The most commonly used behavioural
interventions included hypnosis, relaxation and distraction via guided imagery. Of the twelve
studies investigating the impact of behavioural interventions on cancer treatment‐related
pain, five were randomised clinical trials with either no treatment or attention control
conditions; four of these five supported the efficacy of behavioural intervention and all of the
remaining seven studies, incorporating a variety of designs, found a reduction in pain following
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