Cognitive group therapy in the treatment of catastrophizing in patients with chronic non-cancer musculoskeletal pain

Today, there are numorous studies in which the important role of pain
catastrophizing in relation to various pain-related problems such as pain
intensity, depression, and disability is demonstrated (for an extensive review
see Sullivan et al., 2001). Given this relationship, pain catastrophizing seems
an important starting point in the treatment of chronic pain. Pain
catastrophizing is about an extremely negative way of thinking about pain and
its possible consequences in which threat and fear of pain are important
ingredients. Not surprisingly therefore, pain catastrophizing is closely
related to fearful cognitions about pain. Given this cognitive nature of pain
catastrophizing, it is obvious to use the principles of cognitive therapy in
its treatment. In a meta-analysis of rct's of cognitive behavior therapy for
chronic pain, Morley et al. (1999) found that treatments based on the
principles of cognitive behavior therapy were effective compared to waiting
list conditions. Also, there are two studies that showed that patients with
chronic low back pain treated with cognitive behavior therapy improved on a
number of outcome measures (such as disability, pain intensity, depression and
pain behavior). Moreover, this improvement was mediated by a reduction in pain
catastrophizing (Smeets et al., 2006; Spinhoven et al., 2004). Remarkably, the
level of pain catastrophizing decreased in various treatment conditions and by
using different techniques, even though none of these techniques were
specifically targeted at the reduction of catastrophizing (Smeets et al., 2006;
Spinhoven et al., 2004).
In this study we want to examine whether a treatment specifically aimed at
reducing pain catastrophizing is effective in treating patients with chronic
pain who catastrophize highly about their pain. In this respect the study fits
with the idea that treatments for chronic pain may be improved by tailoring
them to the specific characteristics and needs of the patient (in this case
patiets who catastrophize highly about their pain).
We hypothesize that, compared to a baseline period, the treatment period will
involve a reduction in the level of pain catastrophizing, fear of pain, and
level of disability.

The objective of the study is to gain more understanding of the effectivity of
cognitive therapy, specifically aimed at the treatment of pain catastrophizing
in (chronic) pain.

The study design is a so-called 'replicated single-case experimental design'.
It consists of a baseline period lasting two weeks, followed by a treatment
period of eight weeks (Onghena & Edgington, 2005).

- Onghena, P., & Edgington, E. S. (2005). Customization of pain treatments:
single-case design and analysis. Clinical Journal of Pain, 21(1), 56-68;
discussion 69-72.

The intervention consists of a cognitive grouptherapy of eight weekly sessions
of one and a half hour each.

Participation holds no specific risks for the participants. The burden for the
participants consists of eight 90-minutes sessions of grouptherapy, the
completion of 4 questionnaires on 4 different occasions during the study
(catastrophizing, fear of pain, disability, and pain), and keeping a diary
during the course of the study (63 days). The latter consists of 13 VAS-scales
concerning catastrophizing, fear of pain, disability, and pain. The estimated
total time load is approximately 22 hours.