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Behavioral and Cognitive–Behavioral Treatment for Chronic Pain: Outcome, Predictors of Outcome, and Treatment Process

McCracken, Lance M., PhD*; Turk, Dennis C., PhD

Supplement: Interventional Management of Chronic Benign Spinal Pain Syndromes

Study Design. A literature review was conducted.

Objective. To examine the outcome of behavioral (BT) and cognitive–behavioral treatment (CBT), collectively referred to as BT-CBT, for chronic pain, to identify the predictors of treatment outcome, and to investigate the change processes associated with these treatments.

Summary of Background Data. Numerous controlled clinical trials of BT-CBT for chronic pain, alone or more commonly in multidisciplinary treatment contexts, suggest that these treatments are effective. However, further study is needed to examine which outcome variables change, when, for whom, and how.

Methods. Published literature was gathered from Medline, PsychLit, and searches of relevant journals.

Results. Overall, BT-CBT for chronic pain reduces patients’ pain, distress, and pain behavior, and improves their daily functioning. Differences across studies in sample characteristics, treatment features, and assessment methods seem to produce varied treatment results. Also, some patients benefit more than others. Highly distressed patients who see their pain as an uncontrollable and highly negative life event derive less benefit than other patients. Decreased negative emotional responses to pain, decreased perceptions of disability, and increased orientation toward self-management during the course of treatment predict favorable treatment outcome.

Conclusions. Current BT-CBT helps many patients with chronic pain. Continuing clinical research should improve the matching of treatments with patient characteristics and refine the focus of treatments on behavior changes most associated with positive outcome. Further study of fear, attention, readiness to adopt self-management strategies, acceptance of pain, and new combinations of interdisciplinary treatments may lead to improved interventions.

From the *Royal National Hospital for Rheumatic Diseases and University of Bath, and the

†University of Washington, Seattle, Washington.

Preparation of this manuscript was supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR/AI44724, AR47298) and the National Institute of Child Health and Human Development/National Center for Medical Rehabilitation Research (HD33989) awarded to D.C.T.

Some of the work on this article was completed while the first author was affiliated with the Department of Psychiatry and the Department of Anesthesia and Critical Care at the University of Chicago.

Device Status/Drug Statement: The submitted manuscript does not contain information about medical devices or drugs.

Conflict of Interest: Federal funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address reprint requests to Lance M. McCracken, PhD, Pain Management Unit, Royal National Hospital for Rheumatic Diseases, Bath BA1 1RL, United Kingdom. E-mail:

© 2002 Lippincott Williams & Wilkins, Inc.