Cognitive Behavioral Therapy Helps Patients to Cope with Chronic Pain

Cognitive behavioral therapy (CBT), a psycho-social interventional practice, is used for improving mental health. Initially, it was used for eating disorders, but now a range of issues including post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), anxiety, depression, and anger problems are dealt using it.

An article published by Wolters Kluwer in the Journal of Psychiatric Practice talks of how CBT is a priceless alternative treatment for chronic pain from which millions of noncancer American patients suffer and resort to opioids for finding relief.

Drs. Donna M. Sudak of Drexel University College of Medicine, Philadelphia, and Muhammad Hassan Majeed of Natchaug Hospital, Mansfield Center, Conn., write “Cognitive behavioral therapy is a useful and empirically based method of treatment for pain disorders that can decrease reliance on the excessive use of opiates”. In the article, they discuss proof which supports the employment of CBT to reduce or avoid the use of opioids for chronic pain.

The increasing intake of opioid medications for treating chronic noncancer pain is an important cause of the US opioid crisis. But, though these strong painkillers are powerfully marketed and widely prescribed, Americans report little relief from severe pain.

Drs. Sudak and Majeed write “There is no evidence that supports the intake of opioids for the treatment of chronic pain for more than one year, and heavy intake increases the serious risks of misuse, abuse, addiction, overdose, and death,”.

According to them, a vital alternative to opioids for chronic pain treatment is CBT. CBT aims to aid patients in changing the manner in which they perceive and manage pain. The concept “all pain is in the head” is employed instead of “pain is all in your head”. CBT aids patients in comprehending that pain is a stress causer and, that they can adapt to and cope with this stress causer, just like the case with any other stress causer.

Interventions comprise of organizing pleasant activities, relaxation training, guided exercise, and cognitive restructuring. All these are administered via a validating and empathic relationship with the therapist. Such kind of interventions can reduce the intensity of pain, improve life quality, and enhance emotional and physical function, say the authors.

With this therapy, patients will sense that psychological and emotional factors have an impact on the perception of pain and its behavioral outcomes, they write. The therapy strikes a balance between behavioral and cognitive strategies to help patients to more successfully deal with pain.

The authors have also provided citations of several recent works which validate the effectiveness of CBT and other such approaches for treating chronic pain.

The authors cite several recent original studies and review articles supporting the potency of CBT and other alternative approaches for chronic pain. These say that CBT has a “top-down” effect on realization of painful stimuli and pain control. It has also been found that these bring to normal the gray matter volume in the brain, which are the outcome of chronic stress.

CBT’s effectiveness in reducing pain scores is moderate. And, it can help in reducing or avoiding the risks of opioid addiction, overdose, overuse, and death. It can be employed as a standalone treatment, or along with other treatments like non-opioid medications, or as partly along with opioid intake to reduce dosage.

CBT and similar nondrug treatments are unfortunately underused because of patient demands, limited time, unfamiliarity, low reimbursement rates, and ease of prescribing and consuming drugs. The authors also record that implementing CBT requires the significant investment of resources, as practitioners need to be trained and the therapy has be widely integrated. It would be good if the President’s Commission on the opioid crisis would fund these.

Such a big leap from the current biomedical model of pain prevention and treatment to a biopsychosocial model is the need of the hour, note the authors. They believe that this will ease the pain disorder related social, financial and clinical burdens on the society.

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