Chronic Pain: The Case for Cognitive Behavioral Therapy

An estimated 100 million Americans suffer from chronic pain, which by definition lasts longer than 12 weeks.^1,2 Chronic pain is not limited to physical discomfort; it is a biological, psychological, and social disorder that in many cases persists long after the initial cause has been resolved.^2,3

“Unlike acute pain that warns the body of an injury, chronic pain is no longer a reliable indicator of anything. Even after an injury has healed, chronic pain may trigger reflexive behaviors such as protecting, guarding, and resting that are counterproductive,” Thomas J. Rostafinski, PhD, told Clinical Pain Advisor. Dr Rostafinski is a pain psychologist and clinical associate professor of psychiatry at the Stritch School of Medicine at Loyola University Chicago in Maywood, Illinois.

Cognitive Behavioral Therapy: A Nonmedical Approach

Chronic pain is difficult to treat by nature. Opioids that are effective for acute pain are not appropriate first-line therapy and should be reserved for patients with intractable pain.³ Anticonvulsants that treat neuropathic pain (a common cause of chronic pain) are only effective in a minority of patients, Dr Rostafinski pointed out.

Cognitive behavioral therapy (CBT) is a safe and effective way to treat chronic pain, either alone or in conjunction with other pain therapies. Although mainstream use is supported by decades of research, most patients are never exposed to CBT as a treatment option.¹

For many patients and primary care providers, the suggestion that “talk therapy” can help chronic pain is the first hurdle; the typical response is that chronic pain is not imaginary. Patients may resist, saying, “My pain is not in my head, how is talking going to help me?”

“I would love to ban the term ‘talk therapy’,” Dr Rostafinski emphasized, explaining, “All pain is — literally — in your head. It is real pain that registers in your brain and is processed though the way you see the world. That does not mean it is imaginary.”