Using Cognitive Behavioral Therapy to Control Pain

Many, if not most, people with arthritis understand all too well the challenges that acute and chronic pain present. Treatments for pain abound, but no matter how many medications are developed, pain continues to affect people’s lives in negative ways. That is why using nonmedical, as well as medical, approaches to pain management can provide more options for relief. And believe it or not, one of your greatest nonmedical resources for pain relief is something you already own: your brain. This article explores the ways in which cognitive behavioral therapy for pain can work to retrain your brain and restructure the way you respond to pain.

Sound a little like wishful thinking? Maybe, but according to Mark P. Jensen, PhD, professor and vice chair for research of the department of Rehabilitation Medicine at the University of Washington, Seattle, what a person thinks about pain, and how he thinks about pain, creates his experience of pain.

“What goes through your mind plays a huge role in how you feel,” says Jensen. “Pain is something that is created by the brain — all pain is in the head. What this means is although input from the body plays a role, the most important organ that creates pain is the brain. If you want to treat pain, the best treatments are those that start with the brain.”

Jensen says that anyone who is experiencing pain can add cognitive-behavioral techniques to their pain management program. The techniques used in cognitive-behavioral therapy (CBT) enable people to change the thoughts that automatically spring up in their internal monologues so that they can feel and behave differently. Mental health and pain management professionals use CBT to help people manage a wide range of challenges and conditions. These techniques can also empower individuals to take control of their pain by targeting the perception of it at its source, the brain.

Cognitive restructuring

Cognitive restructuring is a CBT technique, in which people work with a trained health professional to learn how to “restructure” the way they think about their pain. The first step is to identify the thoughts and beliefs that go through your mind and examine whether they are distressing and harmful or whether they are comforting and helpful. The goal is to ultimately increase the amount of time you spend thinking helpful, comforting thoughts. With practice, the thoughts that are harmful can be noted in a detached way, given less importance, and gently shifted to the thoughts that create well-being.

“The idea is to get the client to focus on the more helpful thoughts, and when they do so, they report less pain and a higher quality of life,” Jensen says. “Those who can accept their thoughts as is, both the positive and the negative, and move forward with their goals despite pain levels, are the people who do better.”

Thoughts such as “I am able to manage this pain,” “I have the tools needed to cope,” and “I can live a meaningful life no matter what I am experiencing,” are helpful in restructuring the thought processes related to pain. Admittedly, changing long-held thought patterns is challenging, but a little bit of restructuring or reframing can go a long way. Once you’ve learned how, even starting with 10 minutes of practice each day, and increasing the time spent focusing on the technique as your skills develop, will improve your ability to change which thoughts are allowed to affect your life.

Other CBT techniques

The menu of CBT pain management techniques is large. Cognitive restructuring, deep breathing, meditation, hypnosis, biofeedback, and visualization are just some of the options. If you don’t like one, you can try another. Dr. Eric Matteson, chair of rheumatology at the Mayo Clinic in Rochester, Minnesota, emphasizes that the CBT technique chosen should be tailored to the needs and abilities of the individual, and then re-evaluated to create the most effective program possible.

Dr. Ann Vincent, a doctor of general internal medicine at the Mayo Clinic in Rochester, Minnesota, works on alternative methods of pain management with people who have fibromyalgia. She also echoes the need to individualize cognitive-behavioral strategies.

“The technique depends on the type of patient, their level of education, their personal preference, and how much time they have,” says Vincent. “A patient can start with any of these techniques, but consistency, compliance, and persistence are key to experiencing therapeutic benefits.”

Learning to relax

All cognitive-behavioral pain management strategies are best practiced in a relaxed state of mind, which for many people is a daunting first step. That step can be made easier, however, by getting the right information on how to relax, working with a trained professional, and maintaining the desire to lead a more fulfilling and less painful life. Many institutions offer programs that teach patients how to relax in the face of health challenges. Such programs typically present a few different techniques to give patients options.

Intentional relaxation is the active quieting of both the mind and the body. Have you ever tried to just sit and think of absolutely nothing? How long can you be still before a thought or an item off your to-do list pops into your head? Learning how to relax the mind along with the body can change your biochemistry and, in turn, affect the way you experience pain and life in general. Tuning in to your body on a deeper level, and noting where pain and tension lie, provides important information on where to channel cognitive pain relief efforts.

Deep breathing and progressive muscle relaxation are both good places to start CBT training so you can build a foundation of relaxation skills that can make cognitive restructuring, meditation, and visualization that much easier.

Deep breathing rids the body of carbon dioxide and exchanges it for oxygen, which feeds the mind and body. Many people take short, shallow breaths and hold their bodies in positions that prevent them from taking a deep, complete breath. But breathing deeply can help to alleviate your experience of pain. For instructions on how to add “belly breathing” to your own pain management plan, see Deep Breathing. Instructions for performing progressive muscle relaxation can be found here.

Learning new skills

Learning any new skill takes time and effort. Here are some tips to remember when learning the skills presented here, or any new skills, especially when pain interferes with your will to practice:

Be patient. Learning a new skill takes time! Stay committed to learning, and forgive yourself when you occasionally revert to your old ways.

Be gentle. You will inevitably become distracted as you try to quiet your mind and body. Gently remind yourself to refocus, and try again.

Keep a sense of humor. Many believe there is no better medicine than laughter. Keep it light; don’t stress over your progress.

Find a professional. Find a professional who can initially guide and mark your progress.

Find a partner. Finding a like-minded person who is open to trying new ways of managing pain can provide social support that can keep you going on the days you just feel like pulling the covers back over your head.

Tracy Granzyk Wetzel is a freelance health-care writer in Chicago.

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