Cognitive behavioral therapy may help with pain

Pain is like a fire alarm in the brain, alerting the body to injury or danger, says John (Drew) Sturgeon, PhD, a clinical psychologist and clinical assistant professor in the Department of Anesthesiology at the University of Michigan School of Medicine.

Sturgeon helps patients manage chronic pain so that they can stay positive and keep doing things that are important to them. Remaining active may help lessen their pain, too. 

Why some have chronic pain

“When the brain thinks the body is in danger, it sounds pain as an alarm,” Sturgeon says. “If there is a new injury, that is useful. If I burn my hand on a stove and feel pain, my brain is doing its job correctly. It sends a signal to let me know something is wrong so that I can protect it.”

But if that pain lasts longer than 3 months, it may be chronic. Chronic pain persists even after the danger has passed, an injury has healed, or a disease has been treated.

In a person with chronic pain, the body and brain respond like the body has a new injury even though the injury has already healed. This chronic pain is real, and it is not the patient’s fault, Sturgeon says. It is a signal that something needs to be corrected.

Using CBT as a pain management tool 

Cognitive behavioral therapy (CBT) is a useful tool that can help change your thoughts and reactions to chronic pain, Sturgeon says. It helps you teach your nervous system that the threat is gone and turns off the alarm. CBT can be used with other therapies such as medicine, acupuncture, or other pain-relieving therapies as part of a treatment plan.

It is common to feel depressed, irritable, or angry when there is pain. Pain can make you feel that way even if these are not things you normally feel. It is important to acknowledge those feelings, but it is not helpful to stay that way. 

CBT helps you talk back to those negative thoughts when they happen, Sturgeon says. You can learn to identify negative thought patterns, ask if these thoughts are really true, and replace them with more hopeful, positive thoughts so that they don’t make your life harder. This can help calm your nervous system to quiet that false alarm, and help reduce your pain.

Sturgeon describes “talk back” this way:

“If we notice thoughts come up a lot, thoughts like ‘My life is ruined because of this pain; it will never get better,’ we might get a sense of how much you believe this,” Sturgeon says. “We can ask for some examples where this is not true, of how your life is not ruined. It is almost like playing your own lawyer. Life may be different but let us look at the evidence. Is that really true? Do I really believe that there is nothing I can enjoy?”

You can use other tools with CBT to manage your pain with or without medicine. You can practice deep breathing, muscle relaxation, or imagining something peaceful to reduce stress. These tools can help calm the nervous system and brain, which can also reduce pain. Using CBT can be a helpful addition to other things that you might do such as medicine or exercise. They work best if you do them together. 

You can also learn to accept your pain, rather than avoid it, while your nervous system calms down. It is important to know that accepting pain doesn’t mean giving up – it means trying to figure out what does and doesn’t help reduce pain and trying things that help you get better in the long term. Sturgeon says: “It’s like turning towards the body and saying to the brain, I know it hurts, but look, I can do this.’”  

Then, you can do a little of that activity at a time to teach the brain that the body is OK even if it still hurts a little. This helps you do activities you care about to stay positive, hopeful, and resilient. You can tell your physical therapist what activities you want to be able to do and work toward those goals. You can also speak with your providers and make a plan for how to handle your pain.

How to find a cognitive behavioral therapist

It can be a challenge to find a provider trained in CBT to help with chronic pain.  But you can speak with your doctor or medical insurance carrier for a referral to a pain clinic.  You can also check with your state’s psychological association. You can also find providers online through websites such as:

• Association for Behavioral and Cognitive Therapies 
• Psychology Today 

If you suffer from chronic pain, CBT may help you stay more hopeful and reduce your pain, so you can get back to doing things that matter the most to you.