Tailoring treatment approaches to the individualized needs of cancer patients with pain.

Cognitive-behavioral and behavioral interventions, which have been successfully used to manage chronic pain unrelated to cancer, are an acceptable treatment for the psychobiological factors, including the expression of feelings, associated with pain in cancer patients. However, testing the effectiveness of complex multidimensional programs is difficult because of confounding factors such as progression of disease and measurement of potentially reactive outcomes. Patients were enrolled in theoretically strong individualized treatment programs for 5 weeks, with follow-up observation at 9 and 17 weeks. Weekly strategies were chosen to contribute to the achievement of patient-selected pretreatment goals. Interventions were designed to achieve psychobiological outcomes such as a decrease in inaccurate expectations, an increase in the use of positive comparisons and positive self-statements, a decrease in autonomic arousal, and promotion of self-efficacy. Two case studies provide examples of individual differences in treatment needs and the realities of clinical care.