Stefan Elbers

15 General introduction memory by salient contextual cues and attentional processes, such as the sight of people running in a park that triggers the goal to exercise. Goal conflicts arise when multiple incompatible goals are active at the same time (Boudreaux & Ozer, 2013). For patients with chronic pain, goal conflicts often occur and are related to situations where pain interrupts valued activities (Claes et al., 2018). At these moments, the strength of each particular goal, determined by factors such as motivation, affects the choice of whether to prioritize continuation of an activity or engage in actions related to pain control. These continuous conflicts between valued activities and protective behaviours to control pain or avoid harm pose a constant challenge for individuals with pain. Resolving these conflicts demands cognitive capacity and motivational resources (Baumeister 2014) and, even when people choose to pursue valued activities, the interrupting effect of pain often results in decreased performance (Moriarty et al., 2011). Variation in Clinical Manifestations The sections above illustrate that chronic pain not only has a considerable impact on wellbeing but also involves a network of interacting biopsychosocial factors that allow for many possible clinical manifestations. Indeed, this corresponds to the large variations in baseline measures of distress and depression that have been observed in patients who are about to start treatment (Morley et al., 2013). This justifies a comprehensive approach towards assessment and treatment, tailored to the specific situation of each individual. TREATMENT APPROACHES FOR PATIENTS WITH CHRONIC PAIN Interdisciplinary Multimodal Pain Treatment The impact of chronic pain on daily life activities, valued goals, and one’s identity, described previously, explains why many patients seek medical assistance. Although there is no therapeutic agent available that directly modifies pain intensity, the abundance of modifiable psychosocial variables offers a pathway towards reduced disability and increased wellbeing (Edwards et al., 2019; O’Sullivan et al., 2018). Consequently, most pain management programmes are focused on optimizing self-management, wellbeing and daily life functioning, irrespective of pain (Williams et al., 2020). For patients with substantial disability and loss of quality of life, such therapies are often delivered by multiple health care providers in comprehensive pain management programmes. These programmes originated in response to the inability to provide care for WWII veterans with chronic pain, who experienced a maze of referrals, without a clear diagnosis or adequate treatment. In the 1950s, Dr John Bonica advocated better coordination between disciplines,