The 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
- 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:
Chapman, C. R. 1978. Pain: the perception of noxious events. In: Sternbach, R.A. ed. The Psychology of Pain. New York: Raven Press, pp. 169-202.
Dixon KE, Keefe FJ, Scipio CD et al 2007. Psychosocial interventions for arthritis pain management in adults: a meta-analysis. Health Psychol 26:241-50
Eccleston, C. and Crombez, G. 1999. Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychol Bull 125: 356-366.
Henschke, N. et al. 2010. Behavioural treatment for chronic low-back pain. Cochrane Database SystRev (7), p. CD002014.
Keefe, F. J. et al. 1991. Analyzing pain in rheumatoid arthritis patients. Pain coping strategies in patients who have had knee replacement surgery. Pain 46: 153-160.
Leeuw, M. et al. 2007. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 30: 77-94.
McCracken, L. M. and Keogh, E. 2009. Acceptance, mindfulness, and values-based action may counteract fear and avoidance of emotions in chronic pain: an analysis of anxiety sensitivity. J Pain 10: 408-415.
McCracken, L. M. and Vowles, K. E. 2007. Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: an examination of a revised instrument. J Pain 8: 700-707.
Macfarlane, G. J. et al. 1999. Predictors of early improvement in low back pain amongst consulters to general practice: the influence of pre-morbid and episode-related factors. Pain 80: 113-119.
Pincus, T. and Morley, S. 2001. Cognitive-processing bias in chronic pain: a review and integration. Psychol Bull 127: 599-617.
Schoth, D. E. et al. 2012. Attentional bias towards pain-related information in chronic pain; a meta-analysis of visual-probe investigations. ClinPsychol Rev 32: 13-25.
van der Windt, D. et al. 2008. Psychosocial interventions for low back pain in primary care: lessons learned from recent trials. Spine (Phila Pa 1976) 33: 81-89.
Villemure, C. and Bushnell, M. C. 2002. Cognitive modulation of pain: how do attention and emotion influence pain processing? Pain 95: 195-199.
Waddell G. The Back Pain Revolution. 2nd ed. Edinburgh: Churchill Livingstone: 2004.
Roland M, Waddell G, Klaber Moffett J, Burton K, Main C. The Back Book. Norwich, UK. The Stationary Office: 2007