Jose G. Veliz, M.D. M.S.A.
Medical Director
Palomar Pain Management Center
Pomerado Pain Management Center

Posted December 9, 2008

COGNITIVE BEHAVIORAL TREATMENT (CBT) FOR PAIN MANAGEMENTS

The cognitive-behavioral model of pain is based on the hypothesis that pain is affected by the underlying physiological problem, but also by a person’s affect, knowledge and behavior. Physical examination findings, x-ray findings, MRI findings etcetera are not the only factors in the development of acute or chronic pain. The cognitive-behavioral model states that stress, mood, and the social situation are also important factors in the development of pain. Following an injury, it is obvious that the severity of the injury plays a significant role in the development of pain. What complicates matters is that fear, anxiety, sex, depression and age all play a role as well. The numerous factors involved have implications for treatment. To complicate matters even more, chronic pain leads to worsening depression and anxiety. Worsening depression and anxiety, in turn, increase the severity of pain resulting in a chronic pain patient being caught in a vicious circle.

Cognitive-behavioral therapy for managing pain involves three aspects:

1. Patients are taught how behavior and knowledge affect their perception of pain. In this first component, the importance of controlling one’s own pain is stressed.
2. The second element involves coping skills training. Relaxation techniques are used in order to decrease stress, decrease muscle spasms and to distract oneself from the perception of pain. Distracting oneself from the perception of pain may involve counting methods, imaging pleasant thoughts, etcetera. Patients are taught how to gradually increase the level and extent of their activities. Patients are also taught how to restructure their thoughts so as to replace negative pain related thoughts with more coping, positive thoughts.
3. The third element involves learning how to maintain these coping skills as well as applying learned coping skills to a broader reach of daily events. Using problem solving methods, patients are taught how to dissect and develop strategies for dealing with flare-ups of pain as well as other difficult settings. Finally, patients are taught how to self-monitor in order to prolong the effectiveness of these learned coping skills.

An important part of cognitive-behavioral therapy involves the patient’s physician emphasizing correct posture and strengthening exercises as often as possible. For example, this may involve the physician demonstrating how a spine functions through the use of a spine model and also by determining the person’s fears and beliefs about movements or activities that they would like to undertake. The physician will assist in substituting harmful physical activities with physical activities that will actually strengthen the joints involved and decrease pain. This is an important step in breaking the vicious circle which was discussed earlier in this article. Cognitive-behavioral therapy emphasizes the importance of the mind and body in the perception of pain.

Reference: Keefe, F.J. (1996). Cognitive behavioral therapy for managing pain. The Clinical Psychologist, 49 (3), 4-5.