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CBT for Pain

Traditional Pain Treatment

Traditionally, medical treatments for pain such as drugs and surgery have been the only tools medical professionals had to reduce pain. Unfortunately, medical interventions are only useful for treating acute pain, which is pain with a short duration. Numerous studies have shown these treatments have been mostly ineffective for treating lasting, chronic pain. Interestingly, the fact that individuals who suffer the same degree of tissue damage differ in their reports of painful sensation may shed some light on why medical interventions do not work for chronic pain. Recent developments in pain management point to variation between individuals being only partially accounted for by the underlying tissue damage, with most of the difference accounted for by psychological factors.

Gate Control Theory of Pain

Currently, the best way to account for the factors influencing people’s experience of pain is what’s known as the Gate Control Theory. This way of understanding pain suggests in addition to physical problems influencing pain perception, psychological variables can greatly affect an individual’s pain perception, and consequently response to treatment. In other words, both physical factors, such as nerve fibers, as well as psychological factors are let into the “gate,” and the result is the perception of pain being let out of “the gate.”

Closing the Gate with CBT

“Closing the gate” refers to reduces pain perception. Several factors can do this including physical factors such as medication, emotional factors such as happiness or relaxation, and behavioral factors such as concentration and distractions. Cognitive Behavioral Therapy can work within the gate control theory of pain, and can help with the following:

Improving Physical Functioning and Lifestyle:  CBT objectives include improving muscle tone, self-esteem, self-efficacy, improving distraction and concentration, and decreasing behavior that increases pain.

Decreasing Reliance on Drugs and Medical Services: This involves improving personal control, decreasing behaviors that establish the patient in the “sick role” and increasing self-efficacy.

Increasing Social Support: The aim of treatment in this area to increase optimism and distraction from pain, and increase engagement in activities that take the focus off of pain.

How CBT for Pain Works

CBT works off the premise that pain is influenced by four sources of information:

Cognitions/Thoughts: such as the meaning of the pain (“It will keep me from working”),

Emotions: such as the emotions associated with the pain (I am anxious it will never go away),

Physiological Cues: such as the impulses sent from the site of physical damages, and

Behaviors: such as pain behavior that may either increase the pain (such as decreasing activity) or decrease the pain (such as engaging in regular exercise). 

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