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Exposure Treatment in Chronic Pain: Why, When, and How?

Fear is a response to a real or imagined threat with the function of promoting survival. Fears are protective, and in most cases adaptive. Fear learning in the context of pain typically develops after few encounters with nociceptive stimuli, generalizes quickly, and can be maintained through expectancy of a new episode of pain, increased pain, or expected harm.

Reversing the impact of fear through extinction learning is fragile, complex, and difficult. In-vivo exposure treatments effectively target fear of pain and disability through expectancy violations, exposing patients to previously avoided activities. Similarly, in acceptance and commitment therapy, exposure primarily aims to reduce pain interference by increasing behavioral flexibility. Moreover, when applying exposure to pediatric chronic pain, parent engagement is essential as they contend with the urge to protect their child.

This demonstration workshop will provide the latest experimental evidence on why exposure treatment works. The how and when of in-vivo exposure will incorporate recent advances manipulating the magnitude of prediction error to enhance exposure effectiveness, using digital tools to increase behavioral flexibility and valued living, engaging the family unit, and applying exposure in pediatrics. Participants will engage in behavioral experiments that employ video examples.

Learning Objectives:
Upon completion, participants will be able to:

  • Understand the theoretical underpinnings of exposure treatment for chronic pain and how to apply this model to optimize exposure therapy in (chronic) pain patients.
  • Recognize the potential utility of digital tools to enhance behavioral flexibility and values-based living with an ACT framework.
  • Be exposed to techniques and additional challenges when implementing exposure in pediatric chronic pain that include developmental modifications and engagement of parents.

Credit: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Annenberg Center for Health Sciences at Eisenhower and the International Association for the Study of Pain. The Annenberg Center for Health Sciences at Eisenhower is accredited by the ACCME to provide continuing medical education for physicians.

The Annenberg Center for Health Sciences at Eisenhower designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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