Psychologic treatment

The application of psychology-based treatment to chronic pain is extensively covered in Chapter 13, Self-regulation skills training for adults, including relaxation; Chapter 14, Biofeedback; Chapter 15, Contextual cognitive-behavioral therapy; and Chapter 16, Graded exposure in vivo for pain-related fear in the Practice and Procedures volume of this series. In principle, the management approach is as appropriate to chronic pain sufferers with neurologic disease as to other groups, with perhaps two qualifications.

First, cognitive impairment is a feature of some neurologic disorders and may limit the feasibility of cognitive modification.

Second, physical disability in many painful neurologic diseases may be directly attributable to motor/sensory deficit or dysfunction, in contrast with, for example, the patient with musculoskeletal back pain without neurologic disease whose disability is pain contingent. This may limit the capacity for improving physical function with a cognitive-behavioral management approach.

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