The Effect of Literacy-Adapted Psychosocial Treatments on Biomedical and Biopsychosocial Pain Conceptualization

  • Calia A. Morais
    Address reprint requests to Calia A. Morais, PhD, Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Sciences, College of Dentistry, University of Florida, 2004 Mowry Road, PO Box 100404, Gainesville, Florida, 32610, USA
    Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida

    Center for Pain Research and Behavioral Health, Department of Clinical and Health Psychology, University of Florida, Florida
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  • Andrea K. Newman
    Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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  • Benjamin P. Van Dyke
    Department of Psychology, Young Harris College, Young Harris, Georgia
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  • Beverly Thorn
    Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
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      • Literacy-adapted psychosocial pain treatments produce changes in pain beliefs.
      • Individuals of low-socioeconomic status show improvements in pain beliefs.
      • Teaching patients about the biopsychosocial nature of pain is promising.


      This is a secondary data analysis of a subgroup of participants who received the Learning About My Pain (LAMP) intervention ( identifier NCT01967342). We examined the effects of LAMP on pre-to-post changes in biomedical and biopsychosocial pain conceptualization and whether those changes in pain conceptualization were associated with physical and psychological functioning. Participants were randomized into three conditions: Cognitive Behavioral Therapy (CBT), Pain Psychoeducation (EDU), or Usual Medical Care (UC). Results based on 225 participants who completed the Pain Concepts Questionnaire (PCQ) showed a pre-to-post reduction in biomedical pain conceptualization (BM), an increase in biopsychosocial pain conceptualization (BPS), and an increase in BPS/BM ratio for CBT and EDU but not UC. There were no differences between CBT and EDU in post-treatment PCQ scores. Compared to those with lower BM pain beliefs scores at post-treatment, participants endorsing higher BM pain beliefs scores reported greater pain intensity and greater pain interference. Furthermore, higher BM pain beliefs scores at post-treatment and lower BPS/BM ratio were associated with higher levels of pain catastrophizing. Overall, results of this study suggest the need for targeting specific pain beliefs that influence pain-related outcomes.


      This article presents the potential benefits of providing literacy-adapted psychosocial treatments to expand pain conceptualization beyond a biomedical-only understanding and toward a biopsychosocial conceptualization of the experience of pain. Furthermore, the association of changes in pain conceptualization and pain-related functioning argues for its potential clinical relevance.

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