Lance McCracken, Professor, Avdelningen för klinisk psykologi, Uppsala universitet

A biopsychosocial model is widely disseminated and applied in chronic pain management. Part of the value in this model depends on the success of the psychosocial part. Here we must be able to demonstrate that broadly psychological approaches produce significant benefits for people with chronic pain.  Where we stand right now, after decades of research including many thousands of people with pain conditions, is that the average benefits from psychological approaches are small and many people do not benefit at all. This talk will discuss how we ended up where we are, and what we might do about it. In short, it is suggested that we have relied too much on aggregated group data, RCTs, and meta-analyses. We have too often exclusively conducted comparisons between one static treatment with another static treatment or control, employing outcome variables measured a couple or few times in one group of people compared to one or more groups of other people. Instead we ought to do studies that look at individual people, one at a time, incorporating an emphasis on many observations rather than only on many people, and then deliver treatments that are personalized.  This approach will need to set aside static treatment protocols that pre-specify treatment elements, their dose and order. Instead we should focus on understanding the unique, manipulable, biopsychosocial processes that underlie suffering, decreased functioning, and ill health, for each person, and then dynamically target the processes of change needed so that they achieve the goals they want.