Chronic Pain: An Integrated Biobehavioral Approach

Book Review Chronic Pain: An Integrated Biobehavioral Approach. By Herta Flor and Dennis Turk Chronic Pain: An Integrated Biobehavioral Approach by Herta Flor and Dennis Turk provides health care professionals from all disciplines an understanding of an integrated biobehavioral approach to the treatment of patients with chronic pain. The reader is introduced to biobehavioral concepts and constructs and how these can be applied to chronic pain assessment and treatment modalities. Nurses play a key role in providing seamless care to patients with chronic pain, and this book is an excellent resource for coordinating a biobehavioral approach into practice. Providing chronic pain assessments and clinical tool kits tailored to the complexity of factors influencing assessment and treatment of chronic pain, the book is divided into three parts with a brief glossary and a CD with appendices. The ideal way to read this book is to have computer access close by to refer to the appendices. Case studies provide the reader with anecdotal descriptions of specific assessment techniques and the clinical application of those techniques. For example, the psychophysiology of reflex muscle spasms and their role in influencing an individual’s pain is explained with assessment instruments and treatment strategies are presented. One presented theory explains that a subset of the population has a diathesis or predisposition for chronic pain states, and that chronic pain patients have more in common with each other than with patients with similar injuries or pathologies that do not experience chronic pain. This exemplifies how chronic pain becomes its own syndrome. Also, there is evidence presented for tailoring pain treatment to an individual’s coping style. To provide the best outcome when a chronic pain patient is referred to a behavioral health specialist, there is a detailed script of suggested professional social interactions. An appendix provides details for discussing the stigma that may accompany referral to and treatment by a behavioral specialist so that nurses can use appropriate patient teaching to provide the best outcome. This is an important skill for pain management nursing, because the nurse is frequently the health care professional who spends the most time with patients and supports team collaboration as the patient with chronic pain is referred to a behavioral therapist. These techniques foster a pain management approach becoming truly interprofessional. Part I is a comprehensive introduction to the basic concepts for the biobehavioral assessment and treatment of chronic pain. The biobehavioral approach to chronic pain conceptualizes three levels: verbal-subjective, motor-behavioral, and physiologic. This section provides an unbiased review of chronic pain studies and ranges from basic research to the clinical application and social influence of chronic pain. The biobehavioral conceptual model is presented in a way that someone new to chronic pain care can understand, but also informs the seasoned pain clinician or researcher.

Topics reviewed include emotions and depression with the interdependence of pain and suffering. Maladaptive and positive-influence pain behaviors are presented with an exceptionally detailed explanation of sympathetic activation and increased chronic pain. There is a comprehensive review of learning theories and pain; data are shown on how these theories are correlated with physiologic measures. The roles of operant conditioning and classical (respondent) conditioning are instrumental in the development and treatment of chronic pain. Part II presents how to evaluate a patient with chronic pain. This includes the assessment of biomedical, psychophysiologic, pain perception, pain behavior, and psychosocial factors into a comprehensive assessment protocol to integrate all factors that influence the pain experience. The authors place an emphasis on evaluating the whole patient, not just his or her pain. This includes social relationships and other environmental influences, consistent with nursing theories that include the environment as a part of nursing practice. This section is also an excellent resource for evaluating research instruments that focus on the biobehavioral approach to the chronic pain patient or population. Evaluation of assessment instruments includes discussion of both the advantages and the shortcomings of assessment modalities and standardized instruments. The psychometrics of common pain assessment instruments and techniques are evaluated, informing the reader on evaluating or choosing a valid and reliable pain measure that includes the appropriate variables influencing chronic pain. The importance of combining data from many modes is emphasized. Psychologic scales that may not be commonly used by nurses but are frequently used by behavioral health specialists, such as the Minnesota Multiphasic Personality Inventory (MMPI) and MMPI-2, are presented, along with an explanation of the conversion ‘‘V’’ which is often consistent with chronic pain. Part III explains the concept of a biobehavioral approach to treatment. The goals of behavioral therapy are not to cure the patient of pain but to reduce pain levels and decrease painrelated disability. Common biobehavioral modalities that are summarized include relaxation, biofeedback, autogenic training, and cognitive behavioral therapies. Counseling and education of significant others, who may be reinforcing pain behaviors, is also suggested, as is group therapy including significant others. Patient ‘‘work’’ that is active in shaping maladaptive pain behaviors is explained. The book concludes with a ‘‘new vistas’’ section that outlines newer treatment options with as yet limited research. This provides insight into future biobehavioral approaches to treating patients with chronic pain. The included CD contains standardized common chronic pain assessment instruments and treatment resources that have many applications for those who treat chronic pain patients. Cecile B. Evans, PhD, RN, FNP-BC School of Nursing Boise State University Boise, Idaho

Pain Management Nursing, Vol 14, No 4 (December), 2013: p e289