COGNITIVE METHODS IN THE MANAGEMENT OF CHRONIC PAIN AND TINNITUS

An overview is provided of recent contributions of cognitive theory and therapy to the understanding and management of chronic pain and tinnitus. These two disorders have several features in common, including a chronic course; low efficacy associated with conventional treatments; negative employment, interpersonal, and other consequences of the disorder; little external manifestation of the problem; and a complex set of interrelationships between perception, psychological distress, and environmental events. There has been considerable development of cognitive approaches to the understanding and management of pain, and, to a lesser extent, tinnitus. However, most of the empirical findings can be viewed as descriptions of pain-related phenomena rather than providing strong indications of causal processes. Controlled treatment-outcome studies have revealed significant effects associated with cognitive and behavioural approaches to pain, especially on measures of psychological adjustment. Most studies have failed to demonstrate an effect of psychological procedures on self-ratings of the severity of pain itself. The results obtained with cognitive interventions for tinnitus are less clear. While several studies have indicated beneficial effects on tinnitus-related distress, the effects of treatment have generally been modest when compared with those obtained in the management of pain. There also appears to be some difficulty in achieving long-term maintenance of treatment effects for both pain and tinnitus patients. Thus, the development of relapse-prevention programs remains an important area for further research.