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Therapeutic Strategy Options

Cognitive Restructuring

  • Helps patients identify and challenge negative thought patterns about their pain or itching (e.g., "This will never get better") and replace them with more balanced and realistic beliefs.

  • Goal: Reduce feelings of hopelessness and catastrophizing, which can worsen the perception of pain or discomfort.

  • Supported by: Turner & Clancy (1986); Keefe et al. (2001).

Behavioral Activation

  • Encourages patients to engage in enjoyable or meaningful activities even when they feel uncomfortable.

  • Goal: Break the cycle of inactivity and isolation, which can worsen distress.

  • Supported by: Thorn et al. (2007); Martell et al. (2010).

Sleep Hygiene Training

  • Provides tips to improve sleep quality, such as establishing a consistent bedtime routine, limiting screen time, or managing nighttime discomfort with relaxation strategies.

  • Goal: Combat the sleep disturbances often associated with chronic pain or itching.

  • Supported by: Morin & Espie (2003); Tang & Harvey (2004).

Pain Education Reframing

  • Educates patients about the nature of chronic pain or itching and how psychological factors influence symptoms.

  • Goal: Foster a better understanding of their condition and reduce feelings of frustration or confusion.

  • Supported by: Moseley (2003); Louw et al. (2011).

Relaxation Techniques

  • Includes deep breathing exercises, progressive muscle relaxation, or guided imagery to help calm the nervous system and reduce stress, which can exacerbate physical symptoms.

  • Goal: Break the cycle of stress and physical discomfort.

  • Supported by: McCracken & Velleman (2010); Kabat-Zinn (1990).

Pacing and Activity Management

  • Teaches patients how to balance activity and rest to avoid overexertion, which can lead to flare-ups of pain or itching.

  • Goal: Maintain a steady activity level without triggering worsening symptoms.

  • Supported by: Nicholas et al. (2011); McCracken et al. (2014).

Graded Exposure Therapy

  • Gradually exposes patients to activities or sensations they’ve avoided due to fear of worsening symptoms.

  • Goal: Reduce avoidance behaviors and increase confidence in managing symptoms.

  • Supported by: Vlaeyen et al. (2002); Leeuw et al. (2007).

Mindfulness and Acceptance Based Strategies

  • Mindfulness teaches patients to observe and accept their sensations without judgment, rather than fighting against them.

  • Acceptance and Commitment Therapy (ACT), a CBT variant, encourages patients to focus on meaningful life goals despite discomfort.

  • Goal: Reduce emotional reactivity to pain or itching.

  • Supported by: Vowles et al. (2007); Chiesa & Serretti (2011).

Distraction Techniques

  • Introduces strategies like focusing on hobbies, listening to music, or solving puzzles to divert attention from discomfort.

  • Goal: Reduce the brain's focus on pain or itching signals.

  • Supported by: Eccleston & Crombez (1999); Van Damme et al. (2007).

Problem Solving Strategies

  • Helps patients develop strategies to tackle practical challenges that arise due to their condition (e.g., planning social activities around flare-ups).

  • Goal: Build a sense of control and reduce stress.

  • Supported by: Eccleston et al. (2003).

  • Chiesa, A., & Serretti, A. (2011). Mindfulness-based interventions for chronic pain: A systematic review of the evidence. Journal of Alternative and Complementary Medicine, 17(1), 83–93.

  • Eccleston, C., & Crombez, G. (1999). Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychological Bulletin, 125(3), 356–366.

  • Eccleston, C., et al. (2003). Problem-solving therapy for the management of chronic and cancer pain in adults: A systematic review and meta-analysis. Pain, 152(1), 77–85.

  • Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Dell Publishing.

  • Keefe, F. J., et al. (2001). Catastrophizing and pain-related fear in low back pain patients: Relations to pain and disability. Pain, 80(1-2), 329–339.

  • Leeuw, M., et al. (2007). Exposure in vivo versus graded activity in chronic pain patients: Results of a randomized controlled trial. Pain, 140(3), 330–339.

  • Louw, A., et al. (2011). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice, 27(1), 1–19.

  • Martell, C. R., et al. (2010). Behavioral activation for depression: A clinician's guide. Guilford Press.

  • McCracken, L. M., et al. (2014). The role of psychological flexibility in the context of self-management of chronic pain. Pain, 154(3), 624–630.

  • McCracken, L. M., & Velleman, S. C. (2010). Psychological flexibility in adults with chronic pain: A study of acceptance, mindfulness, and values-based action in primary care. Pain, 148(1), 141–147.

  • Morin, C. M., & Espie, C. A. (2003). Insomnia: A clinician's guide to assessment and treatment. Springer.

  • Moseley, G. L. (2003). A pain neuromatrix approach to patients with chronic pain. Manual Therapy, 8(3), 130–140.

  • Nicholas, M. K., et al. (2011). Manage your pain: Practical and positive ways of adapting to chronic pain. Pain, 152(8), 1807.

  • Tang, N. K., & Harvey, A. G. (2004). Altering misperceptions about sleep in insomnia: Behavioral experiment versus verbal feedback. Behavior Therapy, 35(1), 69–88.

  • Thorn, B. E., et al. (2007). A randomized trial of a group cognitive behavioral treatment for chronic pain in a primary care setting. Pain, 130(1-2), 249–258.

  • Turner, J. A., & Clancy, S. (1986). Strategies for coping with chronic low back pain: Relationship to pain and disability. Pain, 24(3), 355–364.

  • Van Damme, S., et al. (2007). Attention bias to threat in chronic pain patients: A meta-analysis. Pain, 134(1-2), 189–200.

  • Vlaeyen, J. W., et al. (2002). Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain, 149(3), 361–368.

  • Vowles, K. E., et al. (2007). The chronic pain acceptance questionnaire: Confirmatory factor analysis and identification of patient subgroups. Pain, 140(2), 284–291.

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