Toward a Theoretical Model for Mindfulness-Based Pain Management

  • Melissa A. Day
    Address reprint requests to Melissa A. Day, PhD, Department of Rehabilitation Medicine, University of Washington, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Box 359612, Seattle, WA 98104.
    Department of Rehabilitation Medicine, University of Washington, University of Washington School of Medicine, Seattle, Washington
    Search for articles by this author
  • Mark P. Jensen
    Department of Rehabilitation Medicine, University of Washington, University of Washington School of Medicine, Seattle, Washington
    Search for articles by this author
  • Dawn M. Ehde
    Department of Rehabilitation Medicine, University of Washington, University of Washington School of Medicine, Seattle, Washington
    Search for articles by this author
  • Beverly E. Thorn
    Department of Psychology, University of Alabama, Tuscaloosa, Alabama
    Search for articles by this author


      Mindfulness, as both a process and a practice, has received substantial research attention across a range of health conditions, including chronic pain. Previously proposed mechanisms underlying the potential health-related benefits of mindfulness and mindfulness-based interventions (MBIs) are based on a strong theoretical background. However, to date, an empirically grounded, integrated theoretical model of the mechanisms of MBIs within the context of chronic pain has yet to be proposed. This is a surprising gap in the literature given the exponential growth of studies reporting on the benefits of MBIs for heterogeneous chronic pain conditions. Moreover, given the importance of determining how, and for whom, psychological interventions for pain management are effective, it is imperative that this gap in the literature be addressed. The overarching aim of the current theoretical paper was to propose an initial integrated, theoretically driven, and empirically based model of the mechanisms of MBIs for chronic pain management. Theoretical and research implications of the model are discussed. The theoretical considerations proposed herein can be used to help organize and guide future research that will identify the mechanisms underlying the benefits of mindfulness-based treatments, and perhaps psychosocial treatments more broadly, for chronic pain management.


      This focus article presents an initial framework for an empirically based, theoretical model of the mechanisms of MBIs for chronic pain management. Implications of the framework for refining theory and for future research are addressed.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Anderson N.D.
        • Lau M.A.
        • Segal Z.V.
        • Bishop S.R.
        Mindfulness-based stress reduction and attentional control.
        Clin Psychol Psychother. 2007; 14: 449-463
        • Apkarian A.V.
        • Baliki M.N.
        • Geha P.Y.
        Towards a theory of chronic pain.
        Prog Neurobiol. 2009; 87: 81-97
        • Apkarian A.V.
        • Hashmi J.A.
        • Baliki M.N.
        Pain and the brain: Specificity and plasticity of the brain in clinical chronic pain.
        Pain. 2011; 152: S49-S64
        • Baer R.A.
        Mindfulness training as a clinical intervention: A conceptual and empirical review.
        Clin Psychol Sci Pract. 2003; 10: 125-143
        • Baer R.A.
        • Smith G.T.
        • Hopkins J.
        • Krietemeyer J.
        • Toney L.
        Using self report assessment methods to explore facets of mindfulness.
        Assessment. 2006; 13: 27-45
        • Baer R.A.
        • Smith G.T.
        • Lykins E.
        • Button D.
        • Krietemeyer J.
        • Sauer S.
        • Walsh E.
        • Duggan D.
        • Williams J.M.
        Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples.
        Assessment. 2008; 15: 329-342
        • Banks S.M.
        • Kerns R.D.
        Explaining high rates of depression in chronic pain: A diathesis-stress framework.
        Psychol Bull. 1996; 119: 95
        • Barnhofer T.
        • Duggan D.
        • Crane C.
        • Hepburn S.
        • Fennell M.J.
        • Williams J.M.
        Effects of meditation on frontal alpha-asymmetry in previously suicidal individuals.
        Neuroreport. 2007; 18: 709-712
        • Bishop S.R.
        • Lau M.
        • Shapiro S.
        • Carlson L.
        • Anderson N.D.
        • Carmody J.
        • Segal Z.
        • Abbey S.
        • Speca M.
        • Velting D.
        • Devins G.
        Mindfulness: A proposed operational definition.
        Clin Psychol Sci Pract. 2004; 11: 230
        • Boothby J.L.
        • Thorn B.E.
        • Stroud M.W.
        • Jensen M.
        Coping with pain.
        in: Turk D.C. Gatchel R.J. Psychosocial Factors in Pain. Guilford Press, New York1999: 343-359
        • Bowen S.
        • Kurz A.S.
        Between-session practice and therapeutic alliance as predictors of mindfulness after mindfulness-based relapse prevention.
        J Clin Psychol. 2012; 68: 236-245
        • Broderick J.E.
        • Morgan DeWitt E.
        • Rothrock N.
        • Crane P.K.
        • Forrest C.B.
        Advances in patient reported outcomes: The NIH PROMIS measures.
        eGEMs. 2013; 1 (DOI: 10.13063/2327-9214.1015): Article 12
        • Brown C.A.
        • Jones A.K.
        Meditation experience predicts less negative appraisal of pain: Electrophysiological evidence for the involvement of anticipatory neural responses.
        Pain. 2010; 150: 428-438
        • Brown K.W.
        • Ryan R.M.
        The benefits of being present: Mindfulness and its role in psychological well-being.
        J Pers Soc Psychol. 2003; 84: 822-848
        • Brown K.W.
        • Ryan R.M.
        • Creswell J.D.
        Mindfulness: Theoretical foundations and evidence for salutary effects.
        Psychol Inq. 2007; 1: 211-237
        • Burns J.
        • Day M.A.
        • Thorn B.E.
        Is reduction in pain catastrophizing a therapeutic mechanism specific to cognitive behavioral therapy for chronic pain?.
        Trans Behav Med Pract Pol Res. 2012; 2: 22-29
        • Burns J.W.
        • Kubilus A.
        • Bruehl S.
        • Harden R.N.
        • Lofland K.
        Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis.
        J Consult Clin Psychol. 2003; 71: 81-91
        • Burns J.W.
        • Quartana P.J.
        • Bruehl S.
        Anger inhibition and pain: Conceptualizations, evidence and new directions.
        J Behav Med. 2008; 31: 259-279
        • Cahn B.R.
        • Polich J.
        Meditation states and traits: EEG, ERP, and neuroimaging studies.
        Psychol Bull. 2006; 132: 180-211
        • Carmody J.
        Evolving conceptions of mindfulness in clinical settings.
        J Cogn Psychother. 2009; 23: 270-280
        • Carmody J.
        • Baer R.A.
        Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms, and well-being in a mindfulness-based stress reduction program.
        J Behav Med. 2008; 31: 23-33
        • Carmody J.
        • Baer R.A.
        How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress.
        J Clin Psychol. 2009; 65: 627-638
        • Carmody J.
        • Baer R.A.
        • Lykins E.L.B.
        • Olendzki N.
        An empirical study of the mechanisms of mindfulness in a mindfulness-based stress reduction program.
        J Clin Psychol. 2009; 65: 613
        • Castonguay L.G.
        • Constantino M.J.
        • Holtforth M.G.
        The working alliance: Where are we and where should we go?.
        Psychotherapy. 2006; 43: 271-279
        • Chambers R.
        • Gullone E.
        • Allen N.B.
        Mindful emotion regulation: An integrative review.
        Clin Psychol Rev. 2009; 29: 560-572
        • Chiesa A.
        • Serretti A.
        A systematic review of neurobiological and clinical features of mindfulness meditations.
        Psychol Med. 2010; 40: 1239-1252
        • Cieza A.
        • Stucki G.
        • Weigl M.
        • Disler P.
        • Jäckel W.
        • van der Linden S.
        • Kostanjsek N.
        • de Bie R.
        ICF core sets for low back pain.
        J Rehabil Med. 2004; : 69-74
        • Connelly M.
        • Keefe F.J.
        • Affleck G.
        • Lumley M.A.
        • Anderson T.
        • Waters S.
        Effects of day-to-day affect regulation on the pain experience of patients with rheumatoid arthritis.
        Pain. 2007; 131: 162-170
        • Crombez G.
        • Van Ryckeghem D.M.
        • Eccleston C.
        • Van Damme S.
        Attentional bias to pain-related information: A meta-analysis.
        Pain. 2013; 154: 497-510
        • Davidson R.J.
        • Goleman D.J.
        The role of attention in meditation and hypnosis: A psychobiological perspective on transformations of consciousness.
        Int J Clin Exp Hypn. 1977; 25: 291-308
        • Davidson R.J.
        • Kabat-Zinn J.
        • Schumacher J.
        • Rosenkranz M.
        • Muller D.
        • Santorelli S.F.
        • Urbanowski F.
        • Harrington A.
        • Bonus K.
        • Sheridan J.F.
        Alterations in brain and immune function produced by mindfulness meditation.
        Psychosom Med. 2003; 65: 564-570
        • Day M.A.
        • Thorn B.E.
        • Burns J.
        The continuing evolution of biopsychosocial interventions for chronic pain.
        J Cogn Psychother. 2012; 26: 114-129
        • Day M.A.
        • Thorn B.E.
        • Rubin N.
        Mindfulness-based cognitive therapy for the treatment of headache pain: A mixed-methods analysis comparing treatment responders and treatment non-responders.
        Complement Ther Med. 2014; 22: 114-129
        • Day M.A.
        • Thorn B.E.
        • Ward L.C.
        • Rubin N.J.
        • Hickman S.D.
        • Scogin F.
        • Kilgo G.R.
        Mindfulness-based cognitive therapy for the treatment of headache pain: A pilot study.
        Clin J Pain. 2014; 30: 152-161
        • Deikman A.
        The Observing Self.
        Beacon Press, Boston1982
        • Dima A.L.
        • Gillanders D.T.
        • Power M.J.
        Dynamic pain-emotion relations in chronic pain: A theoretical review of moderation studies.
        Health Psychol Rev. 2013; 7: S185-S252
        • Dworkin R.H.
        • Turk D.C.
        • Farrar J.T.
        • Haythornthwaite J.A.
        • Jensen M.P.
        • Katz N.P.
        • Kerns R.D.
        • Stucki G.
        • Allen R.R.
        • Bellamy N.
        • Carr D.B.
        • Chandler J.
        • Cowan P.
        • Dionne R.
        • Galer B.S.
        • Hertz S.
        • Jadad A.R.
        • Kramer L.D.
        • Manning D.C.
        • Martin S.
        • McCormick C.G.
        • McDermott M.P.
        • McGrath P.
        • Quessy S.
        • Rappaport B.A.
        • Robbins W.
        • Robinson J.P.
        • Rothman M.
        • Royal M.A.
        • Simon L.
        • Stauffer J.W.
        • Stein W.
        • Tollett J.
        • Wernicke J.
        • Witter J.
        Core outcome measures for chronic pain clinical trials: IMMPACT recommendations.
        Pain. 2005; 113: 19
        • Eccleston C.
        • Crombez G.
        Pain demands attention: A cognitive-affective model of the interruptive function of pain.
        Psychol Bull. 1999; 125: 356-366
        • Evans D.R.
        • Baer R.A.
        • Segerstrom S.C.
        The effects of mindfulness and self-consciousness on persistence.
        Pers Indiv Differ. 2009; 47: 379-382
        • Felder J.N.
        • Dimidjian S.
        • Segal Z.
        Collaboration in mindfulness-based cognitive therapy.
        J Clin Psychol. 2012; 68: 179-186
        • Fell J.
        • Axmacher N.
        • Haupt S.
        From alpha to gamma: Electrophysiological correlates of meditation-related states of consciousness.
        Med Hypotheses. 2010; 75: 218-224
        • Fjorback L.O.
        • Arendt M.
        • Ørnbøl E.
        • Fink P.
        • Walach H.
        Mindfulness-based stress reduction and mindfulness-based cognitive therapy: A systematic review of randomized controlled trials.
        Acta Psychiatr Scand. 2011; 124: 102-119
        • Frank J.D.
        The dynamics of the psychotherapeutic relationship.
        Psychiatry. 1959; 22: 17-39
        • Fresco D.M.
        • Moore M.T.
        • van Dulmen H.M.
        • Segal Z.V.
        • Ma S.H.
        • Teasdale J.D.
        • Williams J.M.
        Initial psychometric properties of the Experiences Questionnaire: Validation of a self-report measure of decentering.
        Behav Ther. 2007; 38: 234-246
        • Garland E.L.
        • Gaylord S.A.
        • Palsson O.
        • Faurot K.
        • Douglas-Mann J.
        • Whitehead W.E.
        Therapeutic mechanisms of a mindfulness-based treatment for IBS: Effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations.
        J Behav Med. 2011; 35: 591-602
        • Geisser M.E.
        • Roth R.S.
        • Theisen M.E.
        • Robinson M.E.
        • Riley III, J.L.
        Negative affect, self-report of depressive symptoms, and clinical depression: Relation to the experience of chronic pain.
        Clin J Pain. 2000; 16: 110-120
        • Goossens M.E.
        • Vlaeyen J.W.
        • Hidding A.
        • Kole-Snijders A.
        • Evers S.M.
        Treatment expectancy affects the outcome of cognitive-behavioral interventions in chronic pain.
        Clin J Pain. 2005; 21: 18-26
        • Grant J.A.
        • Courtemanche J.
        • Duerden E.G.
        • Duncan G.H.
        • Rainville P.
        Cortical thickness and pain sensitivity in Zen meditators.
        Emotion. 2010; 10: 43-53
        • Grant J.A.
        • Courtemanche J.
        • Rainville P.
        A non-elaborative mental stance and decoupling of executive and pain-related cortices predicts low pain sensitivity in Zen meditators.
        Pain. 2011; 152: 150-156
        • Grossman P.
        • Niemann L.
        • Schmidt S.
        • Walach H.
        Mindfulness-based stress reduction and health benefits. A meta-analysis.
        J Psychosom Res. 2004; 57: 35-43
        • Hanh T.N.
        The Miracle of Mindfulness: A Manual for Meditation.
        Beacon Press, Boston1976
        • Harrington N.
        • Pickles C.
        Mindfulness and cognitive behavioral therapy: A rebuttal.
        J Cogn Psychother. 2009; 23: 333-335
        • Hayes S.C.
        • Luoma J.B.
        • Bond F.W.
        • Masuda A.
        • Lillis J.
        Acceptance and Commitment Therapy: Model, processes and outcomes.
        Behav Res Ther. 2006; 44: 1-25
        • Hayes S.C.
        • Strosahl K.
        • Wilson K.G.
        Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change.
        Guilford Press, New York1999
        • Holzel B.K.
        • Carmody J.
        • Vangel M.
        • Congleton C.
        • Yerramsetti S.M.
        • Gard T.
        • Lazar S.W.
        Mindfulness practice leads to increases in regional brain gray matter density.
        Psychiatry Res. 2011; 191: 36-43
        • Jensen M.P.
        A neuropsychological model of pain: Research and clinical implications.
        J Pain. 2010; 11: 2-12
        • Jensen M.P.
        Psychosocial approaches to pain management: An organizational framework.
        Pain. 2011; 152: 717-725
        • Jensen M.
        • Turner J.A.
        • Romano J.M.
        • Nielson W.R.
        Chronic Pain Coping Inventory: Professional Manual.
        Psychological Assessment Resources, Lutz, FL2008
        • Kabat-Zinn J.
        Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness.
        Delacourt, New York1990
        • Kabat-Zinn J.
        Mindfulness meditation: Health benefits of an ancient Buddhist practice.
        in: Goleman D. Garin J. Mind/Body Medicine. Consumer Reports, Yonkers, NY1993
        • Kabat-Zinn J.
        Mindfulness-based interventions in context: Past, present, and future.
        Clin Psychol Sci Pract. 2003; 10: 144-156
        • Kabat-Zinn J.
        Coming to Our Senses.
        Hyperion, New York2005
        • Kazdin A.E.
        Mediators and mechanisms of change in psychotherapy research.
        Annu Rev Clin Psychol. 2007; 3: 1-27
        • Kazdin A.E.
        Understanding how and why psychotherapy leads to change.
        Psychother Res. 2009; 19: 418-428
        • Keefe F.J.
        • Lumley M.
        • Anderson T.
        • Lynch T.
        • Studts J.L.
        • Carson K.L.
        Pain and emotion: New research directions.
        J Clin Psychol. 2001; 57: 587-607
        • Keng S.L.
        • Smoski M.J.
        • Robins C.J.
        Effects of mindfulness on psychological health: A review of empirical studies.
        Clin Psychol Rev. 2011; 31: 1041-1056
        • Kerns R.D.
        • Jensen M.P.
        • Nielson W.R.
        Motivational issues in pain management.
        in: Hasenbring M. Rusu A. Turk D.C. From Acute to Chronic Back Pain: Risk Factors, Mechanisms, and Clinical Implications. Oxford University Press, New York2012: 453-469
        • Lang P.
        • Bradley M.M.
        • Cuthbert B.N.
        Emotion, motivation, and anxiety: Brain mechanisms and psychophysiology.
        Biol Psychiatry. 1998; 44: 1248-1263
        • Linehan M.M.
        Skills Training Manual for Treatment of Borderline Personality Disorder.
        Guilford Press, New York1993
        • Luborsky L.
        • Rosenthal R.
        • Diguer L.
        • Andrusyna T.P.
        • Berman J.S.
        • Levitt J.T.
        • Seligman D.A.
        • Krause E.D.
        The Dodo bird verdict is alive and well—Mostly.
        Clin Psychol Sci Pract. 2002; 9: 2-12
        • Jensen M.P.
        • Day M.A.
        • Miró J.
        Neuromodulatory treatments for chronic pain: Efficacy and mechanisms.
        Nat Rev Neurol. 2014; 10: 167-178
        • Lutz A.
        • Slagter H.A.
        • Dunne J.D.
        • Davidson R.J.
        Attention regulation and monitoring in meditation.
        Trends Cogn Sci. 2008; 12: 163-169
        • MacKenzie K.R.
        The alliance in time limited group psychotherapy.
        in: Safran J.D. Muran J.C. The Therapeutic Alliance in Brief Psychotherapy. American Psychological Association, Washington, DC1998: 193-215
        • McCracken L.M.
        • MacKichan F.
        • Eccleston C.
        Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: Effectiveness and clinically significant change.
        Eur J Pain. 2007; 11: 314-322
        • McCracken L.M.
        • Morley S.
        The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management.
        J Pain. 2014; 15 ( 221-234
        • McCracken L.M.
        • Vowles K.E.
        • Eccleston C.
        Acceptance of chronic pain: Component analysis and a revised assessment method.
        Pain. 2004; 107: 159-166
        • Melzack R.
        Pain and the neuromatrix in the brain.
        J Dent Educ. 2001; 65: 1378-1382
        • Melzack R.
        Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture: Presented at the Third World Congress of World Institute of Pain, Barcelona 2004.
        Pain Pract. 2005; 5: 85-94
        • Melzack R.
        • Wall P.D.
        Pain mechanisms: A new theory.
        Science. 1965; 150: 971-979
        • Melzack R.
        • Wall P.D.
        The Challenge of Pain.
        Basic Books, New York1982
        • Morley S.
        Efficacy and effectiveness of cognitive behaviour therapy for chronic pain: Progress and some challenges.
        Pain. 2011; 152: S99-S106
        • Nash-McFerron D.E.
        Mindfulness in the treatment of chronic headache pain.
        Diss Abstracts Int. 2006; 67
        • Parra-Delgado P.M.
        • Latorre-Postigo J.M.
        Effectiveness of mindfulness-based cognitive therapy in the treatment of fibromyalgia: A randomised trial.
        Cogn Ther Res. 2013; 37: 1015-1026
        • Pressman S.D.
        • Cohen S.
        Does positive affect influence health?.
        Psychol Bull. 2005; 131: 925-971
        • Raichle K.A.
        • Romano J.M.
        • Jensen M.P.
        Partner responses to patient pain and well behaviors and their relationship to patient pain behavior, functioning, and depression.
        Pain. 2011; 152: 82-88
        • Robbins T.W.
        • Everitt B.J.
        Neurobehavioural mechanisms of reward and motivation.
        Curr Opin Neurobiol. 1996; 6: 228-236
        • Romano J.M.
        • Turner J.A.
        • Jensen M.P.
        • Friedman L.S.
        • Bulcroft R.A.
        • Hops H.
        • Wright S.F.
        Chronic pain patient–spouse behavioral interactions predict patient disability.
        Pain. 1995; 63: 353-360
        • Russel J.A.
        • Barrett L.F.
        Core affect, prototypical emotional episodes, and other things called emotion: Dissecting the elephant.
        J Pers Soc Psychol. 1999; 76: 805-819
        • Safran J.D.
        • Segal Z.V.
        Interpersonal Process in Cognitive Therapy.
        Basic Books, New York1990
        • Segal Z.
        • Williams J.M.
        • Teasdale J.
        Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse.
        Guilford Press, New York2002
        • Segal Z.
        • Williams J.M.
        • Teasdale J.
        Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse.
        2nd ed. Guilford Press, New York2012
        • Shapiro S.L.
        • Brown K.W.
        • Thoresen K.
        • Plante T.J.
        The moderation of mindfulness-based stress reduction effects by trait mindfulness: Results from a randomized controlled trial.
        J Clin Psychol. 2011; 67: 267-277
        • Shapiro S.L.
        • Carlson L.E.
        The Art and Science of Mindfulness: Integrating Mindfulness into Psychology and the Helping Professions.
        American Psychological Association Publications, Washington, DC2009
        • Shapiro S.L.
        • Carlson L.E.
        • Astin J.A.
        • Freedman B.
        Mechanisms of mindfulness.
        J Clin Psychol. 2006; 62: 373-386
        • Smeets R.J.
        • Beelen S.
        • Goossens M.E.
        • Schouten E.G.
        • Knottnerus J.A.
        • Vlaeyen J.W.
        Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain.
        Clin J Pain. 2008; 24: 305-315
        • Smeets R.
        • Vlaeyen J.
        • Kester A.
        • Knottnerus J.
        Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain.
        J Pain. 2006; 7: 261-271
        • Sullivan M.
        • Bishop S.
        • Pivik J.
        The Pain Catastrophizing Scale: Development and validation.
        Psychol Assess. 1995; 7: 524-532
        • Teasedale J.D.
        Metacognition, mindfulness, and the modification of mood disorders.
        Clin Psychol Psychother. 1999; 6: 146-155
        • Thorn B.E.
        • Burns J.W.
        Common and specific treatment factors in psychosocial pain management: The need for a new research agenda.
        Pain. 2011; 152: 705-706
        • Thorn B.E.
        • Pence L.B.
        • Ward L.C.
        • Kilgo G.
        • Clements K.L.
        • Cross T.H.
        • Davis A.M.
        • Tsui P.W.
        A randomized clinical trial to reduce catastrophizing in chronic headache sufferers.
        J Pain. 2007; 8: 938-949
        • Turner J.A.
        • Romano J.M.
        Cognitive-behavioral therapy for chronic pain.
        in: Loeser J.D. Bonica J.J. Bonica's Management of Pain. 3rd ed. Lippincott Williams & Wilkins, 2001: 1751-1758
        • Vlaeyen J.W.S.
        • de Jong J.
        • Leeuw M.
        • Crombez G.
        Fear reduction in chronic pain: Graded exposure in vivo with behavioral experiments.
        in: Asmundson G.J. Vlaeyen J.W.S. Crombez G. Understanding and Treating Fear of Pain. Oxford University Press, Oxford2004
        • Vlaeyen J.W.
        • Linton S.J.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art.
        Pain. 2000; 85: 317-332
        • Wilson S.J.
        • Martire L.M.
        • Keefe F.J.
        • Mogle J.A.
        • Stephens M.A.
        • Schulz R.
        Daily verbal and nonverbal expression of osteoarthritis pain and spouse responses.
        Pain. 2013; 154: 2045-2053
        • Yalom I.D.
        • Leszcz M.
        The Theory and Practice of Group Psychotherapy.
        5th ed. Basic Books, New York2005
        • Zautra A.
        • Smith B.
        • Affleck G.
        • Tennen H.
        Examinations of chronic pain and affect relationships: Applications of a dynamic model of affect.
        J Consult Clin Psychol. 2001; 69: 786
        • Zeidan F.
        • Grant J.A.
        • Brown C.A.
        • McHaffie J.G.
        • Coghill R.C.
        Mindfulness meditation-related pain relief: Evidence for unique brain mechanisms in the regulation of pain.
        Neurosci Lett. 2012; 520: 165-173