13The mainstay psychological intervention for OA is cognitive-behavioural therapy. This usually consists of three phases

  • An education segment in which patients are taught about the biopsychosocial model of pain.
  • A skills training segment in which patients are trained in a variety of cognitive-behavioural coping skills such as relaxation training, activity pacing, pleasant activity scheduling, imagery techniques, distraction strategies, cognitive restructuring, problem solving and goal setting.
  • An application phase in which patients practice and apply their newly acquired skills in real life situations.

Other types of treatment include

  • Emotional disclosure
  • Hypnosis
  • Psychodynamic interventions
  • Acceptance and commitment therapy.

A meta-analysis (Dixon et al 2007) reviewed 27 randomised controlled trials which pooled together different psychosocial interventions, without separating cognitive behavioural therapy which constituted 70% of the interventions for patients with both hip and knee pain. The results for improving pain and improving function after 2-12 months had NNT’s of 10 and 12 respectively.

For more information on psychological therapies that can be accessed by GPs, please see:

http://www.paincommunitycentre.org/article/psychosocial-aspects-cognitive-behavioural-therapy

http://www.paincommunitycentre.org/article/psychosocial-aspects-acceptance-and-commitment-therapy

http://www.paincommunitycentre.org/article/chronic-non-malignant-pain-formulation-based-assessment

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