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Can Talk Therapy Help Manage Pain?

Cognitive behavioral therapy can be a toolbox for dealing with chronic pain, some experts say.

young woman in a therapy session

We’re taking a closer look at chronic pain because it affects patients with rare and serious diseases. This is the first of several articles on pain management and the scientific evidence that supports different approaches.

When we’re dealing with pain, the most common approach simply aims to the decrease the amount of discomfort we feel. Pain management strategies, from medications to massage therapy, attempt to dial back levels of discomfort, allowing patients to improve their quality of life.

In many cases that’s a good strategy, especially for people with temporary pain, such as those recovering from surgery or who’ve thrown their backs out. But when discomfort is chronic, some experts say cognitive behavioral therapy, also known as talk therapy, can be part of the solution. And some research supports this approach.

In cognitive behavioral therapy (CBT), a trained therapist helps a patient explore psychological adaptations to better cope with pain. CBT has been recommended for pain caused by hemophilia and other conditions, including anxiety, substance use and depression. It’s currently being studied to see how it might help pain caused by sickle cell disease. The goal is always the same: Help patients change how they think about pain and create healthier patterns of thought.

Some strategies include breathing exercises, progressive muscle relaxation and guided sessions that help patients visualize more positive outcomes for themselves. It can be used in combination with other treatments, including pain-relieving medicine, and can function like an off-ramp from the steadily compounding stresses that can make dealing with pain feel impossible.

“CBT … is a pain management skills toolbox,” says Drew Sturgeon, a Clinical Psychologist and Assistant Professor in the Department of Anesthesiology and Pain Medicine at the University of Washington Medical School. “It’s meant to give people additional ways to either reduce pain, or to improve some of the things that we know chronic pain can worsen.”

Pain, and chronic pain in particular, causes discomfort and starts a cascade of physical and psychological responses. CBT works by understanding that relationship and intervening before those responses stack up over time.

“There’s some pretty robust research that tells us once the body is starting to show an uncontrolled or prolonged stress response, it can actually worsen the intensity of pain,” Sturgeon says.

Pain can snowball into other problems

After people experience chronic pain, “suddenly all sorts of things in their lives get worse. They suddenly can't sleep, they can’t work, their relationships get harmed,” Sturgeon says. “Once those things are present, they become barriers to pain management. They may not have been the reason you ended up in pain, but you need to address them to get out of pain.”

A trained CBT therapist will work with a patient to develop strategies that minimize psychological distress, maladaptive responses to pain and pain “catastrophization.” A form of the word catastrophe, that means when someone feels overwhelmed by the threat of pain and believes they’re not equipped to cope with it. But it’s important to note that CBT doesn’t mean the person’s pain is “all in their head.”