Cognitive Behavioral Therapy May Increase Acceptance of Chronic Pain

A man in a group counseling session
A man in a group counseling session
A group-based cognitive behavioral therapy intervention may improve pain-related acceptance in veterans with chronic pain.

LAS VEGAS — A group-based cognitive behavioral therapy (CBT) intervention may improve pain-related acceptance in veterans with chronic pain as a result of increased engagement in activities, according to study results presented at PAINWeek 2019, held September 3 to 7 in Las Vegas, Nevada.

The study included 1204 veterans with chronic pain associated with the back, neck, extremities, head, or fibromyalgia who participated in a 12-week pain education program at a Veteran Affairs center between November 2012 and October 2014. A total of 84 study participants (7%; mean age, 59.5 years) volunteered to participate in a CBT intervention, and 50 completed both the pre- and post-intervention assessments.

During the 12-week CBT intervention, participants received psychoeducation about pain, thinking skills, and behavioral skills. The Chronic Pain Acceptance Questionnaire –Revised was used to assess pain acceptance, the study’s primary outcome. Pain-related self-efficacy, health locus of control, quality of life, and illness perception were secondary end points.

From baseline to 12 weeks, veterans participating in the CBT intervention reported a significant increase in overall pain-related acceptance (52.60±12.60 to 57.88±13.90, respectively; P <.001) and an increase in engagement in activities (33.94±10.14 to 37.62±9.40, respectively; P =.001). No change was observed in pain-related willingness from baseline to post-treatment (18.66±6.85 and 20.26±8.08, respectively; P =.120), but pain-related self-efficacy increased at the end of the 12-week program compared with baseline (29.62±10.74 and 34.44±10.58, respectively; P <.001).

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The internal locus of control was found to increase from baseline to post-treatment (21.58±6.01 to 23.68±5.46, respectively; P =.002).  No change was observed in psychological quality of life (52.00±15.61 to 55.82±13.49, respectively) or illness perception (50.64±9.07 to 48.26±8.42, respectively) after the CBT intervention.

Study limitations include the sole participation of veterans with chronic pain attending a single center, the recruitment of a patient population that was predominantly black (84%), as well as the small sample size.

“CBT may increase veterans’ participation in activities of daily living by making plans and engaging in normal life despite the ongoing presence of chronic pain,” study author David Cosio, PhD, ABPP, told Clinical Pain Advisor. “While these results should be considered preliminary, the present study provides insight into potentially different mechanisms of action between CBT and [Acceptance and Commitment Therapy] — decreases in behavioral vs cognitive avoidance — that ultimately result in similar increases in overall pain-related acceptance.”

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Cosio D, Ariel-Donges A. Does cognitive behavioral therapy increase acceptance of chronic pain? A practice-based evaluation amongst veterans. Presented at: PAINWeek 2019, September 3-7, 2019, Las Vegas, Nevada. Poster 16.