Comparison of Cognitive-Behavioral and Behavioral Approaches to the Outpatient Treatment of Chronic Pain

The present study investigated the clinical efficacy of behavioral (BEH) and cognitive-behavioral (CB) outpatient treatments for chronic pain. Twenty-eight patients with long-standing chronic pain refractory to medical and surgical treatment were assigned to one of the two active treatments or a waiting list control condition. After a 10-week treatment phase, patients in the CB and BEH conditions significantly reduced their use of the health care system and reported making significant progress on individually tailored behavioral goals. For both treatment conditions, this progress was maintained at the 6-month follow-up. However, only patients receiving CB treatment significantly improved on multiple self-report measures of pain severity, affective distress, instrumental activities, and dependency. This improvement was significantly maintained at the 3-month follow-up, but only reached a marginal level of significance at the 6-month follow-up. Patients in the waiting list condition did not display any significant changes. These results are discussed in terms of the cost-effectiveness of outpatient treatment and possible directions for future refinements of outpatient CB and BEH treatments of chronic pain.