Cognitive behavioral therapy for chronic pain.

Abstract

C hronic pain has been viewed through a variety of lenses and perspectives over the last century. For example, approximately 50 years ago, chronic pain was viewed by clinicians in much the same way as acute pain. Namely, clinicians believed that once an injury healed, pain would resolve, and if it failed to resolve, the problem was viewed as "psychological" rather than physical. Naturally, this conclusion was quite distressing to patients whose pain persisted; these patients felt their pain was real and not simply "in their heads." However, our current understanding of the etiology of chronic pain has greatly evolved. We are now aware of how biological, psychological, and social factors can impact the experience of pain, and how to address these factors in order to best alleviate suffering. Cognitive behavioral therapy (CBT) for chronic pain now has substantial empirical support, is considered an evidence-based treatment, and is widely used as stand-alone treatment or as part of multidisciplinary pain treatment programs. Research has contributed to our understanding of the various factors that should be considered when providing CBT and, more recently, is focusing on ways in which clinicians can tailor CBT to the specific needs of each patient in order to maximize treatment efficacy.The primary aim of this chapter is to provide a thorough review of the literature on chronic pain and efficacious psychological treatments for pain, focusing on cognitive behavioral approaches. The chapter begins with a review of the definitions of pain, as well as the different types of pain that can be experienced, and data on the prevalence and costs associated with chronic pain.

Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers

“…For example, answering questions like “What evidence is there that this thought is true?,” “What would someone who cared about me say about this thought?,” and “What other possible ways could I view this situation?” are taught and practiced, until the catastrophizing thoughts can be replaced by more helpful and balanced thoughts. Behavioral techniques, such as relaxation exercises and goal setting around physical activity and other valued activities, are used in conjunction with cognitive techniques to improve self‐management skills and pain‐related functioning 59,60 …”

“…CBT‐CP has been adapted for individual, 61 group, 63 and tele‐video settings 64 . There are numerous treatment manuals/patient workbooks 60,65 and more recently, mobile applications have become available to support implementation of CBT skills 66 . Sessions can range from one 2‐hour class 67 to 6–12 weekly 1‐hour sessions.…”

Pain catastrophizing

“…Terry et al 39 note that the catastrophizing intervention can be "easily applied to existing protocols within different therapeutic settings such as clinics and hospitals." 37,38 Brief single-session interventions (up to 30 minutes) that educate patients on how thoughts and feel-ings impact pain and how to develop positive coping strategies have also been shown to be successful in reducing pain catastrophizing. [39][40][41][42][43] Brief psychoeducation, instruction about relaxation and breathing exercises, and reassurance may be useful to address psychosocial factors related to reporting pain and may lead to improved treatment outcomes.…”

“…Consistent evidence demonstrates the therapeutic benefits of reducing pain catastrophizing. Terry et al39 note that the catastrophizing intervention can be “easily applied to existing protocols within different therapeutic settings such as clinics and hospitals.”37, 38…”

Nonsteroidal Anti-inflammatory Drugs vs Cognitive Behavioral Therapy for Arthritis Pain

“…The CBT protocol included 10 modules delivered over 10 weeks in 30-to 45-minute telephone contacts with an experienced psychologist using a treatment manual modified for knee OA based on previously developed and tested materials for chronic back pain. 17 We allowed the time frame to be extended to account for missed sessions. The CBT program consisted of 1 introductory module, 8 pain coping skills modules (deep breathing and visual imagery, progressive muscle relaxation, physical activity and bodily mechanics, identifying unhealthy thoughts, balancing unhealthy thoughts, managing stress, time-based pacing, and sleep hygiene), and concluded with a module emphasizing skill consolidation and relapse prevention.…”