Psychoeducational therapies for nociplastic pain
| Type and components | Description |
|---|---|
| Cognitive behavioral therapy | A technique to cope with pain and convert unpleasant stimuli to pleasant stimuli Focuses on reducing pain and distress by modifying physical sensations, catastrophic thinking, and maladaptive behaviors29 |
| Distraction | Involves engaging in thoughts or activities (eg, finding joy, relaxation techniques, diaphragmatic or belly breathing, social activities) that distract from pain One of the most used and highly endorsed strategies for controlling pain30 |
| Activity pacing | A 2-part strategy that involves spending just enough time on an activity to get the most out of it without pushing so far that patients experience more pain; over time, patients may be able to do more 1. Conserve energy for activities patients value (eg, playing with their kids or undertaking a pleasurable recreational activity) 2. Set graduated activity quotas to help increase ability to do activities (tolerance) and reduce disability |
| Cognitive restructuring | Helps reframe negative thoughts into more positive adaptive thoughts |
| Other | Includes relaxation, guided imagery, and meditation that can be helpful with pain management Telehealth can be an excellent resource, particularly for patients with inadequate access to mental health professionals31 |
| Mind–body therapy | |
| Mindfulness | A nonelaborative, nonjudgmental awareness of the present-moment experience32 Involves breathing methods, guided imagery, and other techniques to relax the body and mind and to help reduce stress Uses cognitive reappraisal to help separate the sensation of pain from the alarm reaction, which reduces the pain experience33 A recent study on veterans with chronic pain showed telehealth-based mindfulness intervention improved pain-related function and biopsychosocial outcomes compared with standard care34 |
| Tai chi | A mind–body activity that combines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation, to move vital energy (or qi) throughout the body A complex multicomponent intervention that integrates physical, psychosocial, emotional, spiritual, and behavioral elements35 Evidence shows clinically important improvements in symptoms, disability, and quality of life in patients with chronic widespread pain36 |
| Yoga | Evidence supports a role in reducing nociplastic pain32 |
| Psychodynamic therapy | An in-depth form of talk therapy that focuses on unconscious processes based on previous unresolved conflicts or dysfunctional relationships that can shape present behavior Goal is to create self-awareness and understand how the past influences present behavior and then rectify it Focuses more on the patient’s relationship with the external world rather than the patient–therapist relationship |
| Hypnosis and hypnotherapy | Explores the subconscious mind and causes an altered state of consciousness to prevent normally perceived experiences, such as pain, from reaching the conscious mind |