Changing thoughts about chronic ailments can provide relief

Chronic pain, generally defined as lasting more than 3-6 months, is widespread and debilitating. In a recent large telephone survey of 15 European countries, a huge 1 in 5 of respondents over 18 years old reported suffering with significant pain for more than 6 consecutive months.

Understandably, the stress that continuous pain puts our bodies and minds under puts people at greater risk of depression and anxiety. Sleep disturbance and insomnia are also common, at almost 80%. Researchers at the prestigious John Hopkins University School of Medicine began to look into how these symptoms may be connected, proposing that they form a vicious cycle: they found that people who ruminate and have more negative thoughts about their pain are less likely to sleep well and, as a result, they then feel more pain. There is a major neurological pathway that links negative thinking about pain to increased pain through disturbed sleep, which seems to be at play here. They refer to this negative thinking as “pain catastrophizing” and found it to be a more robust predictor of pain and pain-related disability than depression, anxiety or neuroticism.

CBT coping strategies can be applied to manage pain in the long term Cognitive Behavioural Therapy seems a perfectly placed psychological therapy to try to break this vicious cycle, allowing patients to feel physically and emotionally better without the need for sleeping pills or pain medication, which both carry great risks of addiction and often entail immediate relapse of symptoms when discontinued.

CBT for pain is based upon a cognitive behavioural model which views pain as a complex phenomenon that is influenced not only by any underlying physical causes, but also by the affected person’s thoughts, emotions and behaviours. This therapy has three main components:

  • A treatment rationale that helps the client to understand that the way they think, feel and behave can affect their experience of pain and emphasises the power that they themselves can hold in controlling their own pain levels
  • Coping skills training which is presented in a variety of cognitive and behavioural tasks such as progressive relaxation (to decrease muscle tension and reduce emotional distress), activity pacing and scheduling (to allow the client to increase the level and range of their activities, and to have events to look forward to and aim towards) and distraction techniques (which can divert attention from the pain episodes). Cognitive restructuring is also used to help the client to identify and challenge negative pain-related thoughts (“pain catastrophizing”) with more adaptive, coping thoughts.
  • The application and maintenance of learned coping skills. This often involves ‘homework’ tasks in which the client is encouraged to apply the adaptive skills and techniques they have learned to situations which call for them in their everyday lives.

The John Hopkins psychologists pursued this cognitive behavioural model of treatment by recruiting and treating over 200 people with a debilitating disorder called TMD: a serious facial and jaw pain which is thought to be stress related in many cases. As predicted, there was a strong and direct correlation between this “pain catastrophizing”, poor sleep, and worse pain. Though sleeping pills and pain medication can help, these pain patients benefited just as much, and in some cases more, from CBT.

The same may prove to be true of other stress-related ailments without a clear underlying pathology, including fibromyalgia, IBS, and some headaches, neck and back pain. An interesting next step in research will be to look at a comparison of relapse rates in CBT versus medication treated chronic pain groups. We would expect relapse rates to be lower in the CBT group who have learned to apply successful coping strategies outside of the therapy room to challenging situations in their everyday lives. Without medication and with no cognitive or behavioural strategies to assist them, the medication-only group may be more vulnerable to relapse.

The House Partnership, 30th April 2013