Tratamiento Al Dolor Cronico

REVISIÓN

503

R e v. Soc. Esp. Dolor 8: 503-510, 2001

Dolor crónico: intervención terapéutica desde la psicología
C. J. van-der Hofstadt* y M. J. Quiles**

van-der Hofstadt CJ and Quiles MJ. Chronic pain: therapeutic intervention based on psychology. Rev

Soc Esp Dolor 2001; 8: 503-510.

SUMMARY
Objective: This paper reviews all the main contributions of psychology to themanagement of chronic pain. This is considered as the result of the interrelationship between sensitive, cognitive and affective factors. Method: The most significant studies have been reviewed on the psychological interventions aimed to reduce or eliminate pain in chronic patients. Results: T h ree main approaches of the problem are considere d : — F rom the physiological point of view, with therapiessuch as training on relaxing techniques and biofeedback, aimed to control the physiological factors underlying the genesis of the disord e r. — F rom the perspective of the operative conditioning, based on the principles of the learning with the same name, which is mainly aimed to eliminate pain behaviors and substitute them by better adapted ones.

—The cognitive-behavioral approach, thatmodifies the a ffective and cognitive factors of the response to pain, using the stress inoculation technique. This paper describes each of the above techniques and analyzes the underlying mechanisms that explain the results. In addition, the need to perf o rm an appropriate previous assessment is emphasized in order to identify the behaviors that need to be modified and the variables that c o n t roltheir occurre n c e . Finally, other contributions of psychotherapy, support therapy and, in particular, hypnosis, are considered, with i n c reasingly effective interventions. Conclusions: It is concluded that all the interventions have some deg ree of effectiveness and that the election of the most appropriate therapy must be based on the individual assessment of each patient. In addition, theneed to continue the re s e a rch and to consider multidisciplinary interventions is c o n s i d e red in order to address the problem of chro n i c pain. Throughout the paper, the usefulness of the management of chronic pain is reminded, stressing the role that psychology can play at diff e rent levels. © 2001 Sociedad Española del Dolor. Published by Arán Ediciones, S.A. Key words: C h ronic pain.Psychological therapy.

RESUMEN
Objetivo: En este trabajo se presenta una revisión de las principales aportaciones realizadas desde la psicología al tratamiento del dolor crónico. Éste es considerado el producto de la interacción de componentes sensoriales, cognitivos y afectivos. Método: Se han revisado los trabajos más significativos sobre las intervenciones psicológicas dirigidas a reducir oeliminar el dolor en los pacientes crónicos. Resultados: Se consideran tres aproximaciones fundamentales al p ro b l e m a :

*Psicólogo clínico Hospital Vega Baja Unidad de Salud Mental de Almoradí. Consellería de Sanidad. Generalitat Valenciana. Profesor asociado. Departamento de Psicología de la Salud. Director del Centro de Psicología A p l i c a d a . Universidad Miguel Hernández. Elche, Al i c a n t e **Psicólogo clínico Centro de Psicología Aplicada. Universidad Miguel Hernández P r o f e s o r-tutor de la UNED Centro Asociado de Elche. A l i c a n t e Recibido: 1 9 - 0 1 - 0 1 . Aceptado: 1 5 - 0 3 - 0 1 .

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C. J. VAN-DER HOFSTA D T y M. J. QUILES

R e v. Soc. Esp. del Dolor, Vol. 8, N.º 7, Octubre-Noviembre 2001

—Desde el área de lo fisiológico, con tratamientoscomo el entrenamiento en relajación y el biofeedback, c u y o objetivo es el control de los factores fisiológicos que subyacen en la génesis del trastorn o . —La perspectiva del condicionamiento operante, basada en los principios del aprendizaje del mismo nombre, que se orienta fundamentalmente a eliminar las conductas de d o l o r, sustituyéndolas por otras más adaptadas. —Y la orientación...