External contingency management for chronic pain: critical review of the evidence

The use of operant conditioning to treat chronic pain has grown rapidly in the past 10 years. It usually occurs in a multidisciplinary inpatient setting with patients for whom nearly everything else has failed. The author reviews the theoretical rationale for this application of contingency management and evaluates the evidence for its efficacy. Although the evidence indicates considerable promise, particularly in improving physical functioning and reducing analgesic use, more definitive conclusions about the role of these methods in treatment of chronic pain are precluded by the methodological limitations of research in this area.