Cognitive-Behavioral Treatments for Chronic Pain: What Works for Whom?

Vlaeyen, Johan W. S.; Morley, Stephen

doi:10.1097/00002508-200501000-00001

Cited by 350Musculoskeletal pain and rehabilitationPain Management and TreatmentPediatric Pain Management Techniques

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Cognitive-Behavioral Treatments for Chronic Pain: What Works for Whom?

Vlaeyen, Johan W. S., Morley, Stephen·2005·The Clinical Journal of Pain

DOI 10.1097/00002508-200501000-00001

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Abstract

Since the introduction of behavioral medicine in the early 70s, cognitive-behavioral treatment interventions for chronic pain have expanded considerably. It is now well established that these interventions are effective in reducing the enormous suffering that patients with chronic pain have to bear. In addition, these interventions have potential economic benefits in that they appear to be cost-effective as well. Despite these achievements, there is still room for improvement. First, there is a substantial proportion of patients who do not appear to benefit from treatment interventions available. Second, although the effect sizes of most cognitive-behavioral treatments for chronic pain are comparable to those in psychopathology, they are quite modest. Third, there is little evidence for differential outcomes for different treatment methods. Fourth, there still is relatively little known about the specific biobehavioral mechanisms that lead to chronic pain and pain disability. One direction is to better match treatment programs to patients' characteristics. This can be done according to an "Aptitude X Treatment Interaction" framework, or from the perspective of the Moderator-Mediator distinction. In this introduction to the special series on what works for whom in cognitive-behavioral treatments for chronic pain, we review existing knowledge concerning both moderating and mediating variables in cognitive-behavioral treatments for chronic pain. We further argue in favor of theory-driven research as the only way to define specific a priori hypotheses about which patient-treatment interactions to expect. We also argue that replicated single-participant studies, with appropriate statistics, are likely to enhance new developments in this clinical research area.

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Individuals vary in their response to treatment.
“However, it is also well known that individuals vary in their response to treatment [9], which calls for a better understanding of the factors influencing treatment outcomes to guide the development of customized interventions with better effects [10].”
From Baseline Pro-Inflammatory Cytokine Levels Moderate Psychological Inflexibility in Behavioral Treatment for Chronic Pain (2022) · cites this paper as [10]
Some people who experience chronic pain do not benefit from CBT interventions.
“However, it is apparent that some people who experience chronic pain do not benefit from CBT interventions.11–14”
From Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial (2014) · cites this paper as [14]
Behavioral health interventions are often needed to meaningfully increase function and quality of life in chronic pain.
“Behavioral health interventions are often needed to meaningfully increase function and QoL [5–7].”
From ACTsmart: Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain—A Pilot Trial. (2021) · cites this paper as [5]

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Background
Examining predictors of treatment effect in digital acceptance and commitment therapy for chronic pain
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Authors: Vlaeyen, J. W. S., & Morley, S.
Affiliations: Maastricht University Medical Centre (NL)
University of Leeds (GB)
Corresponding author: Vlaeyen, Johan W. S.
ORCID: Vlaeyen, Johan W. S.
Morley, Stephen
Venue: The Clinical Journal of Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2005-01
Volume: 21
Issue: 1
Pages: 1-8
ISSN: 0749-8047 (ISSN-L)
DOI: 10.1097/00002508-200501000-00001
OpenAlex: W2119092864
Cited by: 350
References: 67
Citations by year: 2026: 8 · 2025: 7 · 2024: 9 · 2023: 8 · 2022: 14 · 2021: 15 · 2020: 13 · 2019: 15 · 2018: 17 · 2017: 4 · 2016: 19 · 2015: 13 · 2014: 21 · 2013: 24 · 2012: 18
FWCI: 1.82
Type: journal article
Language: en
Open access: closed
Locations: Clinical Journal of Pain (publishedVersion)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion)
Research Publications (Maastricht University) (submittedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords: cognitive behavioral therapy, chronic pain, pain-related disability, treatment moderators, patient-treatment matching, theory-driven research, cost-effectiveness, treatment response variability
MeSH terms: Chronic Disease, Clinical Competence, Humans, Pain, Cognitive Behavioral Therapy, Risk Assessment, Pain Management

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Cognitive-Behavioral Treatments for Chronic Pain: What Works for Whom?

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