The use of brief cognitive behavioral therapy interventions in the treatment of chronic non-cancer pain in the primary care setting

Abstract

As one of the foremost causes of healthcare resource consumption and disability among Canadian adults, chronic non-cancer pain (CNCP) requires significant attention within healthcare delivery and research. While CNCP treatment is typically guided by pharmacotherapeutics, current literature illustrates that Cognitive Behavioral Therapy (CBT) as a CNCP treatment can promote effective pain coping strategies, thereby improving pain and psychosocial outcomes. Cognitive Behavioral Therapy services are constrained, in particular due to limited access and referral to mental health professionals who provide these services. To improve access to CBT services and close gaps in CNCP care, primary care providers could offer brief CBT in their practices. Brief CBT (bCBT) delivered in primary care settings would provide active treatment for CNCP as well as interim treatment for patients awaiting referral to full-service CBT, should that service be required. An integrative literature review has been conducted to identify if Nurse Practitioners, who work in primary care settings, can deliver bCBT to improve outcomes in CNCP patients. The results are discussed within the context of British Columbia (BC) primary care practice. Twelve articles were reviewed using Whittemore and Knafl's approach to the integrative literature review. Results suggest that providers not trained in specific mental health interventions can deliver bCBT to improve CNCP outcomes. Primary care providers are encouraged to seek out opportunities for employing bCBT to gain skill and confidence in providing this treatment. This way, providers can offer multimodal CNCP treatment while also playing an important role in improving access to CBT services. Recommendations for enhancing care of CNCP with bCBT are discussed, and specific strategies for its use in primary care are presented.