Management of Persistent Nonmalignant Pain

Cognitive-Behavioral Therapy

Persistent pain sufferers may demonstrate negative thoughts, which can be related to the emotional difficulty of living with pain. Common patterns include overgeneralization, catastrophizing, all- or-none-thinking, jumping to conclusions, selective attention, and negative predictions.²⁵ In the treatment of persistent pain, one of the most established interventions is cognitive-behavioral therapy (CBT).^18-20Three goals of BT-CBT for pain management are to: (1) help patients understand that their thoughts and behaviors can affect the pain experience, emphasizing the role they can play in controlling their own pain; (2) train patients in effective coping skills; and (3) apply and maintain their learned coping skills. The specific strategies may include education; training in cognitive therapies such as biofeedback, relaxation and imagery; and specific behavioral treatments such as graduated exercise, pacing and time management and sleep hygiene training. The table, Common Components of Behavioral and Cognitive-Behavioral Treatment of Persistent Pain provides more details. Through CBT, patients learn to identify—and change— dysfunctional beliefs and attitudes that adversely affect their ability to cope with pain. Motivating the patient to reduce their social isolation, interact with others, and engage in pleasurable activities is another important component.

CBT may be conducted in individual therapy or in small group sessions of 4 to 8 patients. Both approaches have been effective in clinical trials.¹⁸ CBT is not suitable for patients with substantial cognitive impairment, and healthcare professionals need to have specialized training in CBT to use it effectively.