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OBJECTIVES To develop individual and effective treatment plans for patients with chronic pain, we aimed to replicate Grolimund et al's (2017) empirical categorization of chronic pain patients on a new and larger sample. Moreover, this work aimed to extend previous knowledge by considering various treatment outcomes and exploratorily analyzing which coping skills might be particularly relevant for treatment success in each subtype. METHODS Latent class analysis was used to identify homogenous subtypes with different pain processing patterns using the pain processing questionnaire (FESV). RESULTS By analyzing 602 inpatients with chronic primary pain, we identified three subtypes: (1) severely burdened individuals with low coping skills, (2) mildly burdened individuals with high coping skills, and (3) moderately burdened individuals with moderate coping skills. Pain interference, psychological distress, cognitive and behavioral coping skills improved after treatment in all subtypes. Pain-related mental interference significantly improved only in subtypes (1) and (3). Only individuals of subtype (3) reported significant reductions in pain intensity after treatment. Exploratory regression analysis suggested that of subtype (1), the most promising targets in reducing pain interference and psychological distress post-treatment might be to foster relaxation techniques, counteractive activities, and cognitive restructuring. None of the FESV dimensions significantly predicted treatment outcomes among individuals of subtype (2). Individuals of subtype (3) might benefit the most from experiencing more competence during treatment. DISCUSSION Our findings highlight the importance of identifying and characterizing subtypes of chronic primary pain patients and that these subtypes should be considered for individualized and effective treatment.

As motivation for psychological treatment at intake has been shown to predict favorable outcomes after an inpatient stay, this study aimed to further characterize the different components of psychological treatment motivation that predict favorable treatment outcomes. 294 inpatients with chronic primary pain participating in an interdisciplinary multimodal pain treatment in a tertiary psychosomatic university clinic completed a battery of psychological questionnaires at intake and discharge. Treatment motivation was assessed at intake using the scales of the FPTM-23 questionnaire, while pain intensity, pain interference, anxiety, and depression were assessed both at intake and discharge. After treatment, pain intensity, pain interference, anxiety, and depression were significantly reduced. While higher levels on the FPTM-23 scale of suffering predicted smaller decreases in anxiety after treatment, higher scores on the scale of hope, i.e., lower levels of hopelessness, predicted lower levels of pain interference, anxiety, and depression after treatment. None of the scales of treatment motivation predicted pain intensity levels after treatment. Above and beyond providing symptom relief, reducing hopelessness and fostering hope regarding the treatment process and outcome might help clinicians treat patients with chronic primary pain more effectively.

BACKGROUND Most patients suffering from chronic pain are more susceptible to pain and pressure due to higher pain sensitivity. Since psychosocial factors play a central role in developing and maintaining chronic pain, investigating associations between pain sensitivity and psychosocial stressors promises to advance the biopsychosocial understanding of chronic pain. OBJECTIVES We aimed to replicate Studer et al.'s (2016) findings about associations of psychosocial stressors with pain sensitivity in a new sample of patients with chronic primary pain (ICD-11, MG30.0). METHODS A pain provocation test was used on both middle fingers and earlobes to assess pain sensitivity among 460 inpatients with chronic primary pain. Potentially life-threatening accidents, war experiences, relationship problems, certified inability to work, and adverse childhood experiences were assessed as potential psychosocial stressors. Structural equation modeling was used to investigate associations between psychosocial stressors and pain sensitivity. RESULTS We partially replicated Studer et al.'s findings. Similar to the original study, patients with chronic primary pain showed enhanced pain sensitivity values. Within the investigated group, war experiences (β = 0.160, p

Statt sich an Therapieschulen auszurichten, sollte auch bei der Behandlung chronischer Schmerzen schon in der Aus- und Weiterbildung von Psychotherapeut*innen eine auf allgemeinen Veränderungsmechanismen basierende Weiterbildung treten. Geeignete Vorschläge für mögliche störungsübergreifende Veränderungsmechanismen der kognitiv-verhaltenstherapeutisch ausgerichteten Psychotherapie finden sich bei Hayes und Hofmann (2018). Vorschläge für Veränderungsmechanismen und Interventionen in der Schmerzpsychotherapie jenseits des KVT-Ursprungs machen Lumley und Schubiner (2019). Die Liste der Veränderungsmechanismen und dazugehöriger Interventionen sollte nach aktuellem Wissensstand ständig erweitert werden. Schmerzpsychotherapie nach heutigen Standards ist letztlich Teil einer interdisziplinären multimodalen Schmerztherapie (IMST), die gemäß dem biopsychosozialen Krankheitsmodell stets eine interprofessionelle Zusammenarbeit erfordert., Instead of orienting oneself towards therapy schools, psychotherapy training based on general change mechanisms should also be introduced for the treatment of chronic pain. Suggestions for possible change mechanisms of cognitive-behaviorally (CBT)-based psychotherapy can be found in Hayes and Hofmann (2018). Proposals for change mechanisms and interventions in pain psychotherapy beyond the origin of CBT have been made by Lumley and Schubiner (2019). The list of mechanisms of change and related interventions should be continuously expanded according to current knowledge. Pain psychotherapy according to today’s standards is ultimately part of an interdisciplinary multimodal pain therapy (IMST), which according to the biopsychosocial disease model always requires interprofessional cooperation.