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Cognitive Behavioral Therapy and Chronic Pain, a Study — Comprehensive Pain Centers

Cognitive behavioral therapy is a psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems.

CBT is based on the idea that how we think (cognition), how we feel (emotion) and how we act (behavior) all interact together. Specifically, our thoughts determine our feelings and our behavior. Therefore, negative and unrealistic thoughts can cause us distress and result in problems.

So, how do therapists use cognitive behavioral approaches to treat chronic pain?

The goal of cognitive-behavioral therapy is to change the way you think about the pain so that your body and mind respond better when you have episodes of pain. Therapy focuses on changing your thoughts about illness and then helping you adopt positive ways of coping with illness.

In a recent study, chronic pain patients, already in opioid therapy, added cognitive behavioral therapy to their pain management regimen. This included yoga. The patients with chronic pain receiving long-term opioid therapy who were assigned to cognitive behavioral therapy reported reductions in pain and pain-related disability, data show. 

Opioid use by the patients did not decrease, according to results from a randomized controlled trial published in Annals of Internal Medicine.

Opioids have historically been touted as a solution to long-term management, despite the lack of rigorous evidence. This approach created a host of patient and societal adverse effects. Consequently, viable nonopioid options for long-term management of chronic pain in primary care are needed,” a senior investigator at Kaiser Permanente Washington Health Research Institute, wrote. 

Therefore, patients on long-term opioid therapy can benefit from behavioral treatment.

For the study, a behaviorist, nurse, physical therapist and pharmacist jointly taught pain self-management skills to patients in the intervention cohort during 12 weekly, 90-minute group sessions. The sessions were yoga-based and incorporated relaxation techniques, activity-rest cycling, pleasant activity scheduling, guided imagery and other distraction techniques, emotional regulation skills, cognitive restructuring, problem solving and relapse prevention and maintenance. The intervention team met with primary care physicians to review intake summaries and evaluations before and after the group sessions. 

It was found that patients in the intervention group experienced greater reductions in pain impact and pain-related disability compared with the opioid only care group. Also, one in four patients receiving CBT experienced clinically meaningful reductions in pain (greater than 30%) compared with one in six patients receiving usual care. And behavioral treatments like CBT can be provided effectively within everyday clinical care delivery systems.

The study shows the potential for skill-based, CBT interventions delivered by frontline clinicians to reduce pain impact and improve function among patients with chronic pain receiving long-term opioid treatment. And, though the effects were considered modest, they did persist after treatment through a final 12-month follow-up.

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