Operant therapy with pain patients: evidence for its effectiveness

Abstract

This investigation provides a behavioral conceptualization for clinical pain, a summary of the research supporting such a model, and a more detailed review of the evidence supporting the clinical efficacy of operant learning/conditioning strategies. Within the behavioral model, clinical pain is defined as an interacting cluster of individualized overt, covert, and neurophysiological responses capable of being produced by relevant tissue damage-irritation, and produced and maintained by other antecedent and consequent stimulus conditions. Based on an extensive review of existing research, it is concluded that the behavioral conceptual model as a whole and that portion based on operant conditioning techniques have strong research evidence when applied to patients with chronic low back pain. In contrast, there is insufficient evidence to date supporting the efficacy of operant methods with other chronic painful conditions, acute pain states, pediatric and geriatric pain patients, cancer pain states, or across cultures. Continued research in these and others areas is recommended. Future possibilities and issues surrounding the use of operant conditioning techniques with pain patients, highlighting research needs, are discussed.