IASP Curriculum Outline on Pain for Psychology

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Task Force Members

Amanda C de C Williams (chair), Christine Chambers, Herta Flor, Robert Jamison, Michael Nicholas, Zubaidah Jamil Osman

Outline Summary

Introduction
Principles
Objectives
Curriculum Content Outline
 I. Multidimensional Nature of Pain
 II. Pain Assessment
 III. Management of Pain
 IV. Clinical Conditions

Introduction

The widespread prevalence of pain demonstrates the need for comprehensive pain education for all health-care professionals. Yet not all require the same type of pain-related knowledge and skills. IASP encourages all psychology programs to utilize the following curriculum outline to embed pain education and training. As with other health professions, an objective of curricula is to instill the knowledge and skills necessary to advance the science and management of pain as part of an interprofessional team. The desired outcomes of education emphasize critical competencies that support the humanistic aspects of health care and the learner’s capacity to successfully carry out tasks in the real world. The fundamental concepts and complexity of pain include how pain is observed and assessed, collaborative approaches to treatment options, and application of pain competencies across the lifespan in the context of various settings, populations, and care-team models.

Psychology aims to increase our understanding of behavior and related thoughts and emotions. An integrated bio-behavioral approach is required to address the multidimensional nature of pain and choice of management strategies across the lifespan.

Principles

  1. Pain management requires an integrated bio-behavioral approach based on an understanding of the impact of psychological factors, as well as the peripheral and central nervous systems.
  2. Psychological factors can modulate the sensory and affective dimensions of pain.

Objectives

Psychologists at the end of this entry-level pain curriculum will be able to:

  1. Provide psychology students with an overview of the multidimensional nature of pain from clinical and basic science perspectives.
  2. Introduce pain assessment and measurement strategies for psychologists to use in clinical practice and in research.
  3. Review how many psychological factors, such as attention and expectation, can modulate pain in different experimental and clinical contexts.
  4. Understand the primary psychological therapies and treatments from an evidence-based perspective.

 

Curriculum Content Outline

  1. Multidimensional Nature of Pain
    1. Introduction
      1. Definition of pain
      2. Biopsychosocial perspective for understanding pain and pain behaviors
      3. Classifications of pain: acute, chronic, nociceptive, nociplastic, neuropathic, and other; pain as a disease and as a consequence of ongoing disease
      4. Primary behavioral and psychological factors associated with acute, recurrent, chronic pain
    2. Neurophysiology and mechanisms
      1. Pain in the context of development across the lifespan
      2. Peripheral, spinal, and supraspinal pathways and mechanisms of pain
      3. Cognitive and affective influences on pain, nociceptive pathways
      4. Brain connectome, pain matrix versus salience network
      5. Descending pain modulation, placebo and nocebo
      6. Learning, memory, and brain plasticity
    3. Pain theories and models used in treatment
      1. Modulation of pain by psychological factors
      2. Vulnerability and risk models of chronic pain development
      3. Cognitive-behavioral models
      4. Biases in information processing
      5. Attention, learning, and memory
    4. Ethics
      1. Ethical principles of psychologists
      2. Informed consent and assent
      3. Clinical appropriateness: tenets of autonomy, nonmaleficence, beneficence, justice, and human rights
      4. Rights of patients for assessment and treatment of pain
      5. Access to care, including interdisciplinary management, adequate communication between health-care staff and patients
      6. Racial, ethnic, and sociodemographic disparities in assessment and treatment, language barriers, cultural differences
      7. Legal issues related to the use of controlled substances for the management of pain
      8. Pain in vulnerable populations: infants, children, older adults, people with developmental disorders, people with cognitive impairment
    5. Treatment Outcome and Evaluation Research
      1. Study designs: randomized controlled trial, observational studies, comparative effectiveness research, single-case studies, blinded versus unblinded
      2. Populations, selection criteria, inclusion, and exclusion
      3. Measures: validity, reliability
      4. Sample size, power, effect size
      5. Type I and Type II errors
      6. Outcomes: statistical versus clinical significance
      7. Types of outcome measures: IMMPACT and other guidelines
      8. Meta-analyses
  2. Pain Assessment
    1. Background: Why Pain Assessment Is Important
      1. Acute versus chronic pain
      2. Subjective nature of pain
      3. Models of pain
      4. Pain-related interference
      5. Factors that modulate pain
    2. Goals of pain assessment
      1. Diagnosis and case formulation
      2. Treatment selection
      3. Treatment outcome assessment
      4. Self-monitoring
    3. Types of pain assessment
      1. Self-report
        1. Intensity (worst, least, average, current) versus quality (burning)
        2. Numerical
        3. Categorical, verbal
        4. Visual analogue scales
        5. Faces pain scales
        6. Pain diagrams
        7. Pain diarie
        8. Electronic pain assessment
        9. Pain interview
      2. Observational
        1. Pain behavior
          1. Parent/caregiver, significant other ratings
          2. Health care provider/clinician ratings
          3. Direct observation or video
        2. Adaptive coping behavior
    4. Assessment of pain-related problems
      1. Function
        1. Self-report measures
          1. Work/school
          2. Activities of daily living
          3. Walking
          4. Socialization
          5. Family functioning
        2. Activity monitors
          1. Walking
          2. Posture
          3. Exercise and specific movements
          4. Cumulative activity/activity levels
      2. Sleep
        1. Hours sleeping
        2. Sleep deprivation
        3. Assessment by self-report, activity meters, brain activity monitoring
      3. Negative affect
        1. Anxiety
        2. Depression
        3. Irritability and anger
      4. Cognition
        1. Pain beliefs and expectations
        2. Memory and concentration
        3. Attention
        4. Cognitive capacity and academic achievement
      5. Energy level and fatigue
      6. General quality of life
      7. Other issues
        1. Meaning and significance of pain to individual
        2. Pain in relation to religious beliefs
        3. Cultural beliefs and norms in relation to pain
        4. Legal issues
    5. Assessment of pain beliefs
      1. Self-efficacy
      2. Castastrophizing (including by parents/caregivers)
      3. Coping
      4. Fear and avoidance
      5. Life control
      6. Acceptance and psychological flexibility
    6. Assessment of experimental pain
      1. Pain threshold
      2. Pain tolerance
      3. Pain sensitization/habituation
      4. Quantitative sensory testing
        1. Temporal summation
        2. Pressure algometry
        3. Heat
        4. Cold
    7. Future pain assessment
      1. Innovative technology
      2. Brain imaging assessment
      3. Biomarkers (e.g., cortisol and genome assessment, endogenous opioids)
  3. Management of Pain
    1. Enhancing motivation to change
      1. Specific motivational strategies and motivational interviewing
      2. Strengths and limitations of the motivational enhancement methods
      3. Developmental and cognitive factors affecting motivation
    2. Early Intervention
      1. Conceptual background
        1. Aim of prevention by early intervention
        2. Primary, secondary, and tertiary intervention
        3. Developmental factors in the onset and maintenance of chronic pain
        4. Identification of barriers to intervention
      2. Identification of increased risk for chronicity based on group-level statistical associations
        1. Medical risk factors
        2. Psychosocial risk factors, including workplace and socio-economic risk factors
        3. System risk factors
        4. Screening tools for risk
      3. Integration of early psychosocial intervention into clinical practice
        1. Primary care and occupational health
        2. Awareness of stepped-care versus risk-based care plans
        3. Educational interventions
        4. Early rehabilitation program
        5. Evidence on efficacy of the forgoing
      4. Promotion and maintenance of health
        1. Individual health behaviors (exercise, physical fitness, stress management)
        2. Management of health behavior in the workplace and community
      5. Specific issues in prevention
        1. Time-points for intervention
        2. Active participation and adherence
        3. Communication among involved parties and stakeholders (family, professionals, insurers, workplace)
        4. Accommodating role of economic factors
      6. Strengths and limitations of prevention and early interventions
    3. Operant treatment
      1. Operant conditioning model applied to pain
        1. Reinforcement, punishment, and extinction
        2. Discriminative stimulus control
        3. Functional behavioral analysis
        4. Response generalization
      2. Reinforcement of “well” behaviors
      3. Social reinforcement
      4. Training of spouses and family members, parents as therapists
      5. Methods for maintaining and generalizing treatment gains
      6. Strengths and limitations of the operant treatment approach, including extinction and extinction memory
    4. Relaxation and Biofeedback
      1. Models of psychophysiological reactivity, including developmental factors
      2. Relaxation
        1. Rationale for relaxation and evidence/lack of evidence
        2. Protocols for relaxation
          1. Progressive muscle relaxation
          2. Autogenic relaxation
          3. Diaphragmatic breathing
          4. Guided imagery
          5. Mindfulness meditation
          6. Brief relaxation methods
      3. Negative side-effects of relaxation (panic attacks and relaxation-induced anxiety)
      4. Biofeedback
        1. Rationale for biofeedback
        2. Protocols for biofeedback training
          1. EMG for various types of musculoskeletal pain
          2. EEG neurofeedback
          3. Thermal
          4. Heart rate
          5. Respiration
          6. GSR
    5. Cognitive-behavioral treatment
      1. Cognitive-behavioral model of pain: integrating C and D with cognitive methods
        1. The role of feelings, thoughts, and behavior
      2. Treatment rationale
      3. Behavioral reactivation by integrating cognitive and behavioral methods
      4. Cognitive therapy: identifying, challenging, and changing unhelpful beliefs and ways of thinking
      5. Skills training
        1. Pleasurable and meaningful activity scheduling
        2. Defining goals and intermediate steps
        3. Establishing baseline tolerance levels and size of increments
        4. Attention methods, including interoceptive training imagery techniques
        5. Problem solving
        6. Assertiveness training
        7. Managing sleep disturbances
        8. Weight management
        9. Emotion regulation
        10. Practice and relapse prevention methods
      6. Exposure in vivo for pain-related fear
        1. Fear and avoidance model of chronic pain
        2. The paradoxical effects of reassurance
        3. Fear hierarchy
        4. Behavioral experiments
        5. Stimulus generalization
      7. CBT for disease-related pain
      8. Evidence base for CBT, strength and limitations of CBT
    6. Acceptance and commitment therapy (ACT) and mindfulness
      1. Theory and treatment rationale
      2. Main features, distinction from CBT
      3. Evidence base, strengths, and limitations
    7. Other psychological methods
      1. Application of hypnosis to pain
        1. Treatment rationale and methods
        2. Evidence, strengths, limitations
      2. Neuroplasticity-based approaches to pain treatment
        1. Rationale and methods, such as sensory discrimination training, mirror treatment, graded motor imagery, extinction training, virtual reality
        2. Evidence, strengths and limitations
      3. Family therapy for chronic pain
        1. Rationale and systems methods
        2. Evidence, strengths and limitations
        3. Improving social support
    8. Psychological treatment of children's pain
      1. Psychological aspects of children’s pain
      2. Family factors
        1. Child and parent behaviors in relation to pain
        2. Engagement of family in treatment
      3. School attendance and school refusal
      4. Peer factors and social functioning
      5. Developmental factors that impact delivery of psychological interventions for pain
      6. Evidence, strengths and limitations
    9. E-health, m-health, use of phone, internet, apps, and emerging technologies to deliver elements of forgoing treatment
    10. Interdisciplinary treatment approaches
      1. Nature of multidisciplinary and interdisciplinary pain treatment
        1. Purpose of multi/interdisciplinary treatments
        2. Distinction between multidisciplinary and interdisciplinary
        3. Organization and description of pain clinics and pain centers
      2. Specific role of the psychologist
        1. Specific assessment skills, including interview methods
        2. Assessment of the social context of consultation, including the specific role of the spouse and family
        3. Identification of specific psychological treatment goals and obstacles to progress
        4. Psychological preparation of the patient for pain management
        5. Application of cognitive-behavioral strategies, relaxation techniques, contingency management to both patient and significant other/family
        6. Role as a mediator/interventionist within the team
      3. Strengths and limitations of the interdisciplinary treatment approach
      4. Involving partners, family, and others important in the patient’s environment
  4. Clinical Conditions
    1. Classification
      1. DSM classification
      2. ICD classification
      3. IASP classification
    2. Comorbidity
      1. Multiaxial classification of chronic pain and associated disease
      2. Multiple pain problems and spread of pain
      3. Psychological disorders; e.g., anxiety, depression, trauma
      4. Medical conditions; e.g., cancer, diabetes, HIV
      5. Psychiatric disorders; e.g., dementia, obsessive compulsive disorder, developmental disorder
      6. Substance-use disorder; e.g., opioid addiction

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