Cognitive Behavioral Therapy for Chronic Pain

Living with chronic pain is often associated with a decreased quality of life, and diminished state of mind and can put a lot of stress on one’s mental health. When your body aches, you know the pain is just not “in your head,” and the discomfort is real. Pain becomes your whole world. 

Frequently, patients consider conventional ways of thinking: reducing activities and resting will reduce pain. However, the opposite typically occurs. When you reduce movement and daily activities, your body automatically reduces its capacity to function properly. This change in behavior leads to negative thoughts about pain – “will I ever be pain-free?” or “nothing helps my pain.” 

This type of negative thinking affects other aspects of your life, leading to anxiety and depression. That is when therapies like Cognitive Behavioral Therapy are helpful. 

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a form of talk therapy. It has been researched and proven effective across a myriad of diagnosed conditions.  It helps people identify and develop skills to change negative thoughts and behavior. CBT is problem-focused and challenges the negative thoughts, beliefs, or concerns contributing to a patient’s mental health regarding their pain. It is more than a stereotypical therapy session that involves talking through a problem and focuses on “doing” things. 

The science behind CBT says that individuals – not events or external stimulants – create their own experiences. This includes pain. People can train themselves to incorporate coping skills into their daily lives by changing awareness of pain and thought patterns. For patients with chronic pain, CBT helps patients break their pain cycles and improve their quality of life.  

How is it used to Treat Chronic Pain?

Used to treat chronic pain, CBT is commonly used with other modalities of pain management. This may include massage therapy, medications, or physical therapy. CBT has minimal risk and side effects than medication or in extreme cases, surgery, making it an excellent treatment option. 

Cognitive behavioral therapy can change a physical response in the brain that worsens pain. Pain causes stress which in turn affects the pain chemicals in the brain. CBT reduces the activity of those chemicals, making the body’s natural pain relief more effective. 

The first step of CBT is education. When patients understand their diagnosis and how CBT can help, it is easier to set goals and get in the correct mindset. It also helps the patient identify triggers and behaviors that worsen their pain levels and allows them to learn adaptive behavior. The goal is to increase self-efficacy for managing and reducing chronic pain by correcting negative thoughts and beliefs. Cognitive behavioral therapy is used to treat conditions that are caused by chronic pain, such as depression, anxiety, sleep disorders, and isolation. 

What to Expect from CBT Sessions

CBT sessions vary depending on your provider and pain level, but the initial meeting may be used to normalize the patient’s experience. This involves normalizing their pain – they are not “crazy” or wrong for feeling their pain sensations. The pain is not “all in their head,” and they do not see a “shrink.” These are common concerns and worries of patients who suffer from chronic pain conditions. 

There will be a clinical interview where patients are screened through a series of questions, self-reporting, and observations. This allows the doctor to provide feedback about their situation and allows them to educate them about how CBT can be used to help manage pain. 

Paper material that use visuals to show the relationship of chronic pain and how it impacts feelings, behavior, thoughts, and their cycle of pain. When patients are able to understand and see these connections, it is easier to relate it to their lives. Visual materials also provide patients with assistance at home, promoting self-efficacy. 

Cognitive behavioral therapy aids patients’ development of their own behavior. It “trains” them how to think, act, and feel regarding their pain. The sessions focus on teaching the importance of paced activities that increase function without overexerting yourself and how inactivity can worsen your pain. This trained development allows the patient to create specific, relevant, and achievable goals for themselves. It is often called SMART Goals: Specific, Measurable, Achievable, Relevant, Time-Limited goals. 

By slowly incorporating activities into your daily routine, it takes away from the mindset of “My pain limits me” or “I can’t do this.” Once a mindset shift has been activated, any negative mood symptoms begin to dissolve. 

CBT is often part of a comprehensive treatment plan, used in conjunction with interventional pain management techniques. The team at AOA Ortho works with your other healthcare providers to ensure you get the most out of your treatment plan and the highest quality of care possible. 

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