Flipping the Script 
on Chronic Pain

By: Michael Ferguson
Wednesday, April 30, 2014

Pathophysiological pathways are only one aspect of pain. Cognitive behavioral therapy (CBT) aims to restructure perceptual and behavioral problems that can exacerbate painful symptomatologies.

A growing body of cross-disciplinary literature supports the efficacy of integrating CBT into a multidisciplinary approach to chronic pain management. Used in a wide-ranging spectrum of conditions — from chronic lower back pain to post-traumatic stress disorder following heart attacks — CBT helps patients identify the ways in which their perception of pain impacts their lives.

As Francis Keefe, PhD, writes in The Clinical Psychologist, the initial component of CBT “helps patients understand that cognitions and behavior can affect the pain experience and emphasizes the role that patients can play in controlling their own pain.” For many, pain can be a self-perpetuating experience, degrading their quality of life. Instead of allowing patients to fall into a destructive cycle of pain and the fear of pain, CBT equips them with tools to use at the onset of recognized triggers associated with painful symptoms.

For example, after suffering an initial heart attack, patients may fear a second so much that increased heartbeats following exercise can initiate a consuming fear that “the big one” is always right around the corner. Similarly, chronic back pain may steep patients in such perpetual agony they begin to identify themselves as victims, powerless to control it, according to Carrie Winterowd, PhD, et al., in an article published by the Academy of Cognitive Therapy.

After pinpointing triggers that initiate maladaptive behaviors, therapists train patients in a number of techniques designed to help them better cope with the experience of pain. Deep breathing and relaxation techniques can calm patients, allowing them to confront symptoms in a more thoughtful, controlled way. Distraction techniques utilizing pleasant imagery, counting or concentration techniques can help patients deflect attention away from their pain.

Winterowd and her co-authors note that CBT can transform perceptual and behavioral issues surrounding the pain experience and achieves optimal results as part of a multifaceted approach, including medications and physical therapy.

An Adjunctive Tool

While analgesic intervention often sufficiently addresses acute events, CBT offers patients of all ages effective methods for managing chronic pain. Weekly, psychologist-led group therapy sessions typically span eight to 10 weeks, and after completion, patients are better equipped to cope with their experiences of pain. While not meant to replace critical medicinal therapies addressing physiological causes of pain, CBT has been shown to help reduce medication dosage for some patients.