Improving non-optimal results in chronic pain treatment : a tripartite approach

摘要

The outcome of almost all chronic pain treatment programs is (partly) non-optimal. In most treatment programs, the greater majority of patients do show improvement after treatment. Despite these successes, there are almost always patients who show no improvement or who even deteriorate in functioning after completion of the treatment program. Failing significant improvements in treatment programs, this kind of variability in treatment results will remain. In this dissertation, the treatment variability of the cognitive-behavioral therapy (CBT-R) program at the Roessingh Center for Rehabilitation (RCR) is demonstrated through a randomized controlled trial (RCT) (Chapter 2). Additionally, an attempt is made to explain treatment variability of this program by: 1) determining whether treatment variability is the result of the existence of subgroups of chronic pain patients; 2) relating treatment variability to factors in the treatment process; and 3) investigating whether treatment variability is attributable to insufficient or incorrectudunderlying theoretical mechanisms. For the latter, the eneralizability and value of the match-mismatch (MM) mechanism in explaining the maintenance of chronic pain is explored. Additionally, the influence of the CBT-R program on pain expectations in daily life is examined. The search for explanations for the existing variability in treatment results of the CBT-R program is imperative if we want to be able to identify what needs to be changed in order to improve the overall treatment effect of the CBT-R program.