Chronic Pain

  • Steven Zlutnick
  • C. Barr Taylor


The management of chronic pain has become a major problem for the health care industry. Those individuals who fit the so-called chronic pain syndrome are particularly difficult to treat and consume a large portion of health care time and resources, as well as a disproportionate share of the health care dollar relative to their demonstrable pathology. For example, the treatment of low back pain alone costs the health care system billions of dollars every year (Holden, 1979). This syndrome, appropriate to a subset of pain patients, has been described by Black (1975) as one of intractable pain of at least 6 months duration, multiple pain complaints that are inappropriate or out of proportion to existing physical prob1ems, frequent abuse of a wide variety of analgesic and hypnosedasive medications, use of the medical system characterized by polysurgery,polyaddiction and polymedicine. In this chapter we will focus on the assessment, treatment and research on chronic-pain syndrome patients, although the procedures to be discussed are equally applicable to chronic-pain patients with demonstrable pathology.


Chronic Pain Behavioral Medicine Pain Behavior Pain Tolerance Pain Report 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Anderson, T. P., Cole, J. M., Gullickson, G., Hudgens, A., & Roberts, A. H. Behavior modification of chronic pain: A treatment program by a multidisciplinary team. Clinical Orthopedics, 1977, 129, 96–100.Google Scholar
  2. Beecher, H. K. Measurement of subjective responses: Quantitative effects of drugs. New York: Oxford University Press, 1969.Google Scholar
  3. Beecher, H. K. The placebo effect as a non-specific force surrounding disease and the treatment of disease. In R. Janzen, W. D. Keidel, A. Herz, C. Steichele, J. P. Payne, & R. A. P. Burt (Eds.), Pain: Basic principles, pharmacology, therapy. Stuttgart, West Germany: Georg Thieme, 1972.Google Scholar
  4. Black, R. G. The chronic pain syndrome Surgical Clinics of North America1975, 55, 4. Blanchard, E., & Allies, T. A. Behavioral treatment of psycho-physiological disorders Behavior Modification1979, 3, 518–549 Google Scholar
  5. Blitz, B., & Dinnerstein, A. J. Effects of different types of instructions on pain parameters Journal of Abnormal Psychology1968, 73, 276–280 Google Scholar
  6. Blitz, B., & Dinnerstein, A. J. Role of attentional focus in pain perception: Manipulation of response to noxious stimulation by instructions. Journal of Abnormal Psychology, 1971, 77, 42–45.PubMedCrossRefGoogle Scholar
  7. Bobey, J. J., & Davdison, P. O. Psychological factors affecting pain tolerance Journal of Psychosomatic Research1970 14371–376 Google Scholar
  8. Bowers, K. S. Pain, anxiety, and perceived control Journal of Consulting and Clinical Psychology1968 32596–602 Google Scholar
  9. Cairns, D., Thomas, L., Mooney, V., & Pace, J. B. A comprehensive treatment approach to chronic low back pain Pain1976 2301–308 Google Scholar
  10. Chertock, L. Psychosomatic methods of preparation of childbirth American Journal of Obstetrics & Gynecology1967 98698–707 Google Scholar
  11. Corley, M. J., & Zlutnick, S. A model for liason-consultation with chronic pain patients. In J. Ferguson, & C. B. Taylor (Eds.), Comprehensive handbook of behavioral medicine. Hollingswood, N.Y.: Spectrum, 1980.Google Scholar
  12. Diagnostic and Statistical Manual of the American Psychiatric Association, III American Psychiatric Association, 1980.Google Scholar
  13. Egbert, L. D., Battit, G. E., Welch, C. E., & Partlett, M. D. Reduction of postoperative pain by encouragement and instruction of patients. New England Journal of Medicine, 1964, 270, 825–827.PubMedCrossRefGoogle Scholar
  14. Ferster, C. B., & Skinner, B. F. Schedules of reinforcement. New York: Appleton-CenturyCrofts, 1957.CrossRefGoogle Scholar
  15. Fordyce, W. E., Fowler, R. S., & Delateur, B. An application of behavioral medicine tech-nique to a problem of chronic pain. Behavior Research and Therapy, 1968, 6, 105–107.CrossRefGoogle Scholar
  16. Fordyce, W. E. Behavioral methods for chronic pain and illness St.Louis: C. V. Mosby,1977.Google Scholar
  17. Fordyce, W., Fowler, R., Lehmann, J., Delateur, B., Sand, B., & Trieschmann, R. Operant conditioning in the treatment of chronic pain. Archives of Physical Medicine and Rehabilitation, 1973, 54, 399–408.PubMedGoogle Scholar
  18. Gardner, W. J., & Licklider, J. D. R. Auditory analgesia in dental operations Journal of the American Dental Association1959, 59, 1144–1149 Google Scholar
  19. Gottlieb, H., Strite, L. C., Koller, R., Madorsky, A., Hockersmith, V., Kleeman, M., & Wagner, J. Comprehensive rehabilitation of patients having chronic low back pain. Archives of Physical Medicine and Rehabilitation, 1977, 58, 101–108.Google Scholar
  20. Greene, R. J., & Reyher, J. Pain tolerance in hypnotic analgesic and imagination states Journal of Abnormal Psychology1972, 79, 29–38 Google Scholar
  21. Halpern, L. M. Psychotropic drugs and the management of chronic pain. In J. J. Bonica (Ed.), Advances in neurology: International symposium on pain. New York: Raven Press, 1974.Google Scholar
  22. Holden, C. Pain, dying, and the health care system. Science, 1979, 203, 984–985.PubMedCrossRefGoogle Scholar
  23. Horan, J. J., & Dellinger, J. K. “In vivo” emotive imagery: A preliminary test. Perceptual and Motor Skills, 1974, 39, 359–362.PubMedCrossRefGoogle Scholar
  24. Johnson, J. E., & Rice, V. H. Sensory and distress components of pain: Implications for the study of clinical pain. Nursing Research, 1974, 23, 203–209.PubMedGoogle Scholar
  25. Karoly, A. J., Winger, G., Ikomi, F., & Wood, J. H. Reinforcing properties of ethanol in the rhesus monkey. Psychopharmacology, 1978, 58, 19–25.PubMedCrossRefGoogle Scholar
  26. Lamaze, F. Painless childbirth. Chicago: Henry Regery, 1970.Google Scholar
  27. Lehrer, P. M. Physiological effects of relaxation in a double-blind analog of desensitization. Behavior Therapy, 1972, 3, 193–208.CrossRefGoogle Scholar
  28. McAmmond, D. M., Davidson, P. 0., & Kovitz, D. M. A comparison of the effects of hypnosis and relaxation training on stress reactions in a dental situation. American Journal of Clinical Hypnosis, 1971, 13, 233–242.PubMedCrossRefGoogle Scholar
  29. Mello, N. K., & Mendelson, J. H. Drinking patterns during work contingent and noncontingent alcohol acquisition. In N. K. Mello & J. H. Meldelson (Eds.), Recent advances and studies in alcoholism: An inter-disciplinary symposium. Washington, D.C.: National Institute of Mental Health, 1970.Google Scholar
  30. Melzack, R., & Torgerson, W. S. On the language of pain. Anesthesiology, 1971, 34, 50–59.PubMedCrossRefGoogle Scholar
  31. Mersky, H., & Spear, F. G. Pain: Psychological and psychiatric aspects. Baltimore: Williams & Wilkins, 1967.Google Scholar
  32. Newman, R. I., Seres, J. L., Yospe, L. P., & Garlington, B. Multidisciplinary treatment of chronic pain: Long-term follow-up of low back pain patients. Pain, 1978, 4, 283–292.PubMedCrossRefGoogle Scholar
  33. Pollack, S. Pain control by suggestion. Journal of Oral Medicine, 1966, 21, 89–95.PubMedCrossRefGoogle Scholar
  34. Seres, J. L., & Newman, R. L. Results of treatment for chronic low back pain at the Portland Pain Center. Journal of Neurosurgery, 1976, 45, 32–36.PubMedCrossRefGoogle Scholar
  35. Staub, E., Tursky, B., & Schwartz, G. E. Self-control and predictability: Their effects on reactions to aversive stimulation. Journal of Personality and Social Psychology, 1971, 18, 157–162.PubMedCrossRefGoogle Scholar
  36. Sternbach, R. A. Pain patients: Traits and treatment. New York: Academic Press, 1974.Google Scholar
  37. Stitzer, M., Bigelow, G., Lawrence, C., Cohen, J., D’Lugoff, B., & Hawthorne, J. Medication take-home as a reinforcer in a methadone program. Addictive Behaviors, 1977, 2, 9–14.Google Scholar
  38. Stone, C. I., Demchick-Stone, S. A., & Horan, J. J. Coping with pain: A comparative analysis of Lamaze and cognitive-behavioral procedures. Journal of Psychosomatic Research, 1977, 21, 451–456.Google Scholar
  39. Swanson, D. W., Floreen, A. C., & Swenson, W. M. Program for managing chronic pain. II. Short-term results. Mayo Clinic Procedings, 1976, 51, 409–411.Google Scholar
  40. Taylor, C. B., Zlutnick, S., Corley, M. J., & Flora, J. The effects of detoxification, relaxation and brief supportice therapy on chronic pain. Pain, 1980, 8, 319–329.PubMedCrossRefGoogle Scholar
  41. Thompson, T. & Pickens, R. (Eds.), Stimulus properties of drugs. New York: AppletonCentury-Crofts, 1971.Google Scholar
  42. Turk, D. Cognitive control of pain: A skill training approach. Unpublished manuscript, University of Waterloo, 1975.Google Scholar
  43. Tursky, B. The pain perception profile: A psychophysical approach. In M. Weisenberg & B. Tursky (Eds.), Pain: New perspectives in therapy and research. New York: Plenum Press, 1976.Google Scholar
  44. Wooley, S. C., Blackwell, B., & Wingate, C. Alerting theory model of chronic illness be-havior: Theory, treatment and research. Psychosomatic Medicine, 1978, 40, 379–401.PubMedGoogle Scholar
  45. Zlutnick, S. Recent advances in behavioral medicine. Paper presented at the Nevada Na-tional Conference on Humanistic Behavior Modification, Las Vegas, Nevada, March 1976.Google Scholar
  46. Zlutnick, S., Taylor, C. B., Corley, M. J., & Flora, J. Stimulus control of pain behavior. Unpublished report, 1977.Google Scholar
  47. Zlutnick, S., Corley, M. J., & Owens, M. The assessment and management of chronic pain. Workshop presented at the annual meeting of the Association for the Advancement of Behavior Therapy, San Francisco, December 1980.Google Scholar

Copyright information

© Plenum Press, New York 1982

Authors and Affiliations

  • Steven Zlutnick
    • 1
  • C. Barr Taylor
    • 2
  1. 1.Department of Educational Psychology/CounselingUniversity of San Francisco and Pacific Medical CenterSan FranciscoUSA
  2. 2.Department of PsychiatryStanford UniversityStanfordUSA

Personalised recommendations