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Behavior Therapy for Pain Management (Reprinted from Pain Management Psychotherapy: A Practical Guide by Bruce Eimer, Ph.D. & Arthur Freeman, Ed.D. I enjoy convalescence. It is the part that makes the illness worthwhile. --George Bernard Shaw Behavioral interventions directly address the problem of promoting compliance with pain treatment. Because noncompliance is a major problem that often depotentiates the efficacy of treatments for pain patients (Meichenbaum & Turk, 1987; Turk etal., 1983), behavioral interventions are an essential component of PMP. Pain management therapies that ignore behavioral issues are doomed to fail. Although this is a strong statement, it generally holds true: In a sense, behavioral interventions are the glue that hold everything else together. Fordyce (1976, 1988) contributed greatly to the field of pain management by elucidating the role of operant behavioral conditioning principles in the genesis and maintenance of pain behavior problems. These principles not only appear to govern the natural history of such problems, but also provide effective guidelines for formulating a behavioral cure. As in all good therapy, however, the pain management therapist must be consistent and persistent in applying operant and respondent conditioning techniques, and cognitive therapy techniques as well, in the remediation of pain behavior problems. By "consistent," we mean (a) having an adequate cognitive-behavioral and psychophysiological conceptualization of the case, and understanding of the patient's physical and medical problems, (b) providing the patient with clear rationales and definitive instructions that are adequately broken down into implementable steps,(c) sticking to the principles of the program, and (d) not vacillating by shifting the focus or the ground rules arbitrarily. By "persistent," we mean that the therapist must be diligent in following up on problems with patients, and conscientious in not giving up. This involves determining the reasons for noncompliance, and addressing them to promote compliance. Behavioral Excesses and Deficits The mainstay of the behavioral approach is the targeting of operationally defined indices of behavior for assessment and
