The Role of Behavioral and Psychological Interventions in Chronic Ocular Pain

Abstract Purpose of Review Chronic ocular pain (COP) is a debilitating condition in which patients experience pain in or around the eyes. It is strongly associated with other pain and psychological conditions. Management options remain limited and available ocular therapies are rarely effective, particularly in patients with central sensitization. As in other pain conditions, psychological and behavioral interventions are important, yet understudied and underutilized in the management of COP. This review explores the literature pertaining to such interventions for COP. Recent Findings COP, while previously thought of as dry eye disease, is now accepted as a separate pain entity. It overlaps with other chronic pain conditions and is also associated with depression, anxiety, post-traumatic stress disorder, sleep disturbance, pain catastrophizing, fear avoidance, and somatic symptom burden, which can be conceptualized through a biopsychosocial model. In broader chronic pain populations, cognitive behavioral therapy, mindfulness-based interventions, acceptance and commitment therapy, pain neuroscience education, emotional awareness and expression therapy, and behavioral interventions have demonstrated benefit for pain-related distress, coping, function, and disability. However, evidence supporting such interventions for COP remains limited, and no formal investigation of psychological interventions for COP has been published to date. Summary The reviewed literature provides supportive evidence for psychological and behavioral interventions as mechanism-based adjuncts for COP management within a biopsychosocial framework. Integrating these approaches through multidisciplinary care models emphasizing pain psychology may help address central pain contributors and functional disability. COP-specific trials are needed to define which patients will most benefit, optimal interventions, and implementation models in practice.