Differentiated psychocorrection in complex rehabilitation of patients with chronic back pain

Relevance. Chronic back pain is a complex phenomenon that arises as a result of the dynamic interaction of biological, psychological and socio-cultural determinants and requires special attention from specialists of a multidisciplinary rehabilitation team. Intense and prolonged pain experience leads to a decrease in the ability to perceive the information and introspection, the forms of a pathological pattern of pain behavior, which reduces the effectiveness of the generally recognized method of cognitive behavioral psychotherapy and draws the attention of specialists to the use of scholastic approaches, in particular, work with the figurative sphere of a person. At the same time, the multivariance and the possibility of choosing among various techniques, including modern high-tech tools, require a detailed study of indications and contraindications for their reasonable and safe use.

Intention. To evaluate effectiveness of inclusion of various types of psychocorrection in the comprehensive rehabilitation of patients with chronic back pain.

Methodology. Using the psychodiagnostic «McGill Pain Questionnaire», the subjective perception of pain was studied in 166 patients who were at the second, inpatient, stage of medical rehabilitation. The duration of moderate intensity pain was (10.9 ± 9.0) years. For psychocorrection, patients were randomized into four groups: two main groups, a comparison group and a control group. Patients of the main groups and comparison group attended classes with a medical psychologist at the «Patient’s School», patients of the main groups additionally attended art therapy classes or procedures using a «Virtual reality Helmet»; patients of the control group were involved only in psychodiagnostic activities with the possibility of receiving psychocorrective services after completion of the inpatient medical rehabilitation.

Results and Discussion. Based on a differential approach to determining the qualitative characteristics of pain (nociceptive or mixed), it was shown that in 58.4% of patients the pain was nociceptive, in 41.6% – mixed (neuropathic and dysfunctional). Analysis of the significance of differences in the magnitude of the shift in pain intensity in groups of patients with nociceptive pain, depending on the nature of rehabilitation measures, demonstrated maximum improvements only with art therapy sessions. In the patients with mixed pain, significant shifts resulted from rehabilitation measures including psychocorrection with a high-tech virtual reality (VR) helmet and in the group attending «Patient’s School». The results obtained can be explained taking into account psychological mechanisms of sensory processing in patients with mixed pain and indicate lower effectiveness of complex psychocorrection in comparison with single-component exposure when working with mixed modality pain.

Conclusion. The results of the study showed that the specificity of intrapsychic processing of sensory information in patients with chronic back pain makes it feasible to construct a program of differentiated psychocorrection depending on the nature of pain.

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