The expression of pain, in other words, the behaviour of an individual might vary depending on the mental status of person in chronic pain.5 The expression might get heightened either because of anxiety or depression secondary to unrelieved pain. These emotional aspects will require modification along with the conventional pain management techniques.

This therapy (sometimes called operant conditioning) is aimed at changing habits, behaviours and attitudes that can develop in chronic patients. Some patients become dependent, anxious and homebound – if not bedridden. For some, too, chronic pain may be a welcome friend, relieving them of the boredom of a dull job or the burden of family responsibilities. These psychological rewards – sometimes combined with financial gains from compensation payments or insurance – work against improvements in the patient’s condition, and can encourage increased drug dependency, repeated surgery, and multiple doctor and clinic visits. There is no question that patient feels pain.

The hope of behaviour modification is that pain relief can be obtained from a programme aimed at changing the individual’s lifestyle. The program begins with a complete assessment of the painful condition and a thorough explanation of how the program works. It is essential to enlist the full cooperation of both the patient and family members. The treatment is aimed at reducing pain medication and increasing mobility and independence through a graduated program of exercise, diet, and other activities. The patient is rewarded for positive efforts with praise and attention. Rewards are withheld when the patient retreats into negative attitudes or demanding and dependent behaviour.