Chronic Pain: The Case for Cognitive Behavioral Therapy

Changing the Way Patients Think About Pain

CBT comprises a group of psychotherapy methods focused on changing thoughts, emotions, and behaviors. There is no standard protocol; techniques may include relaxing activities, meditation, setting behavioral goals, and activity pacing.1,4

“CBT is the psychotherapy of choice for many conditions. It is a collection of techniques and approaches based on the specific needs of the patient. The cognitive and behavioral components are distinct parts of treatment. One goal is to counter reflexive but counterproductive reactions to pain,” Dr Rostafinski said.

Chronic pain may cause a person to withdraw from life. Symptoms may include fatigue, depression, mood changes, and sleep disturbances. Some patients dwell on the pain, mourning the loss of the life they formerly enjoyed.

“Many of these people have lost a lot. The goal is to regain as much as possible. The first step is to get over the misconception that hurt means harm. Distraction is a powerful coping skill. My mantra for patients is get active physically, mentally, socially, and — for those who choose to — spiritually,” Dr Rostafinski said.

Effective for a Wide Range of Syndromes

CBT can be used for a wide range of chronic pain syndromes and is the most useful psychological treatment for arthritis, headache, low back pain, orofacial pain, and fibromyalgia.1

“The etiology of the pain may be different, but all pain is experienced psychologically and processed in similar ways. The only type of pain that may not respond as well to CBT is migraine headache. That one seems to be a different type of animal,” Dr Rostafinski noted.

How Long Does Treatment Last?

CBT is often described as a short-term treatment, involving as few as 6 sessions or as many as 20. In many cases, CBT skills can be learned quickly and used indefinitely.4

“The length of treatment is hard to predict. A standard answer may be about 3 months of weekly sessions. In that time, you will know if the treatment is working or not. CBT is no different from physical therapy or a pain injection. As long as CBT is helpful, some people will benefit from returning over time,” Dr Rostafinski said.