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Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach

By Elizabeth Shimer Bowers
WebMD Feature

Your body is aching and the pain feels unbearable. The last thing you want to hear is, “it’s all in your head.” For people with chronic pain, the discomfort is very real, and they know all too well they feel it in their bodies.

“If you are lying in bed and hurting, the pain is your whole world,” says Joseph Hullett, MD, board certified psychiatrist and senior medical director for OptumHealth Behavioral Solutions in Golden Valley, Minn.

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Enter cognitive behavioral therapy as a method of pain management.

Cognitive behavioral therapy (CBT) is a form of talk therapy that helps people identify and develop skills to change negative thoughts and behaviors. CBT says that individuals -- not outside situations and events -- create their own experiences, pain included. And by changing their negative thoughts and behaviors, people can change their awareness of pain and develop better coping skills, even if the actual level of pain stays the same.

“The perception of pain is in your brain, so you can affect physical pain by addressing thoughts and behaviors that fuel it,” Hullett tells WebMD.

What can CBT do for you? Cognitive behavioral therapy helps provide pain relief in a few ways. First, it changes the way people view their pain. “CBT can change the thoughts, emotions, and behaviors related to pain, improve coping strategies, and put the discomfort in a better context,” Hullett says. You recognize that the pain interferes less with your quality of life, and therefore you can function better.

CBT can also change the physical response in the brain that makes pain worse. Pain causes stress, and stress affects pain control chemicals in the brain, such as norepinephrine and serotonin, Hullett says. “CBT reduces the arousal that impacts these chemicals,” he says. This, in effect, may make the body’s natural pain relief response more powerful.

To treat chronic pain, CBT is most often used together with other methods of pain management. These remedies may include medications, physical therapy, weight loss, massage, or in extreme cases, surgery. But among these various methods of pain control, CBT is often one of the most effective.
“In control group studies, CBT is almost always as least as good as or better than other treatments,” Hullett says. Plus, CBT has far fewer risks and side effects than medications or surgery.

To help provide pain relief, cognitive behavioral therapy:

  • Encourages a problem-solving attitude. “The worst thing about chronic pain is the sense of learned helplessness -- ‘there is nothing I can do about this pain,’” Hullett says. If you take action against the pain (no matter what that action is), you will feel more in control and able to impact the situation,” he says.
  • Involves homework. “CBT always includes homework assignments,” Hullett says. “These may involve keeping track of the thoughts and feelings associated with your pain throughout the day in a journal, for example. “Assignments are then reviewed in each session and used to plan new homework for the following week.”
  • Fosters life skills. CBT is skills training. “It gives patients coping mechanisms they can use in everything they do,” Hullet says. You can use the tactics you learn for pain control to help with other problems you may encounter in the future, such as stress, depression, or anxiety.
  • Allows you to do it yourself. Unfortunately, good qualified cognitive behavioral therapists aren’t available in all areas. Luckily, you can conduct CBT on your own as a method of pain control, even if you’ve never set foot in a therapist’s office. “CBT is a cookbook approach. It can easily be applied to self-help and computerized programs,” Hullett says. And the literature supports that these self-help methods can be just as effective for pain management as one-on-one sessions.

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