Chronic pain is a very common type of pain which is affects both physiology and psychology of a person. A pain is considered to be ‘chronic’, if the pain continues beyond the time expected for a painful condition or injury to heal, usually about 3 months or more (The Australian Pain Management Association Ltd. (APMA) , 2018). The constant pain affects the person’s day to day lives, in which it makes the person prone to psychological distress such as depression and anxiety. Furthermore, long term chronic pain can lead to: increase in negative feelings, pain catastrophizing, social stigma, and depression. Chronic pain falls in the category of biopsychosocial model, and numerous treatments have been developed in order to treat chronic pain. The most effective form of psychological intervention to treat chronic pain is the cognitive behavioural therapy, which focuses entirely on practical self-help strategies (Victoria, 2019).
Cognitive behavioural therapy is a psychological intervention that is used to treat the psychological and physiological effects of chronic pain. The primary focus of cognitive behavioural therapy is to change unhealthy and/or unhelpful thoughts, behaviour and coping mechanisms of a person (Healthdirect, 2019). The cognitive behavioural therapy is the combination of two types of therapies: ‘cognitive therapy’ and ‘behaviour therapy’.
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The aim of cognitive therapy is to change a person’s way of thinking about an issue which causes concern. This is done by challenging the negative thoughts and maladaptive coping mechanisms of a person and replacing it with healthier coping strategies. A common technique in cognitive therapy is ‘Cognitive reconstructing’, this is when a person learns to identify the negative thoughts and replace them with realistic and positive thoughts (Victoria, 2019). The behaviour therapy identifies a person’s behaviour/s and help change potentially self-destructive behaviour’s. The behaviour therapy functions on the idea of a behaviour is a learned trait, therefore; I can be changed by replacing ‘dangerous’ behaviour with one that is ‘productive or helpful’ to the person (T.J.Legg, 2014).
“The perception of pain is in your brain, so you can affect physical pain by addressing thoughts and behaviours that fuel it”, (bowers, 2016). The cognitive behavioural therapy is an effective form of therapy for those suffering from chronic pain. It changes people’s perception of pain and by recognising pain, the pain becomes insignificant and the pain interferes with a one’s quality of life a little less, thus; optimising their functions in day to day life. Furthermore, cognitive behaviour therapy changes the physical response in the brain which leads to catastrophizing pain. Pain causes stress in a person and the stress increases the production of adrenaline and serotonin, in order to control the chemicals released by the brain “cognitive behaviour therapy reduces the arousal and the impacts of the chemicals” (Hullett, 2011). Consequently, this improves the person’s natural pain relief response. In addition, cognitive behaviour therapy is very effective due to its nature of being self-help, this gives the person coping mechanisms in treating chronic pain and can also help in the future to treat the residual effects of chronic pain such as anxiety or depression.
A study was conducted by Dawn M. Ehde from university of Washington titled ‘Cognitive-Behavioural Therapy for Individuals with chronic pain’, and in this research the treatment of CBT has been shown to present a positive set of results. The results yielded by the study supports the prevalence of the CBT in treating chronic pain, CBT had positive impact on pain, pain-related discomfort, depression, anxiety, and health related quality of life (Hoffman, Papas, Chatkoff, and Kerns, 2007). Furthermore, cognitive behavioural therapy had proven to be effect during post-treatment, the observations were made by the research team and the team observed the patients to have used CBT to treat minor pain related issues (Henschke et al., 2010). Patients using CBT post-treatment highlighted the self-help aspect of the treatment, thus; giving the patient knowledge about their condition and how to treat it effectively.
The treatment of cognitive behavioural therapy has been tested on various groups of test subjects. This ranges from: children and adolescence, and older adults who are suffering from chronic pain (Judith A. Turner, 2014). As each group received CBT treatment for chronic pain the children and adolescence had the clinically significant success rate of >50% improvement in pain post-treatment. However, during one of the test that was conducted a group yielded no significant results from the CBT treatment they had received becoming an outlier (Tiara M. Dillworth, 2014). On the other hand, the adult group whom are suffering chronic pain was also been treated with CBT but the symptoms of chronic pain were prevalent. The adult group that were diagnosed with chronic pain is suffering from wide range of issues caused by chronic pain, such as: pain related distress, depressive symptoms, denial, pain catastrophizing, and low self-efficacy dealing with pain. After cognitive behavioural therapy had been administered nearly half of the patients (44%) made a clinically meaningful improvement at one-month post treatment and the other 42% of the subjects were predicted to make significant improvement over next two to four months (Judith A. Turner, 2014).
There are other approaches to chronic pain such as: opioid medication, nonsteroidal anti-inflammatory medication, and mindfulness. Treatments such as opioid medication and nonsteroidal anti-inflammatory drugs were administered on a group of adults aged 20 – 70, the results yielded by both those treatments were had poor results of mere 22% success rate. In addition, the side effects of the drug treatment showed a small effect on the patients physical functioning, with no statistically significant impact for depression or depressive symptoms and miss use of medicinal drug use (Tiara M. Dillworth, 2014). The mindfulness treatment is closely related to cognitive behavioural therapy which focuses on by increasing the acceptance of pain rather than minimising the pain. The mindfulness therapy revolves around the notion of stress reduction of acceptance of pain. In order to identify which treatment is better (mindfulness vs. CBT) researcher Melissa and her team conducted a study. At the end of the experiment both groups yielded promising results of CBT with (P < 0.01) and mindfulness at (P < 0.05) (Melissa, 2016). Mindfulness treatment was less effective than CBT due to methodological shortcomings and mindfulness does not provide the patient with adequate coping mechanisms compared to CBT.
In conclusion, cognitive behavioural therapy is the most effective form of psychological intervention that is suitable for those suffering from chronic pain but is not limited to chronic pain but can also be used for other problems such as depression and anxiety. CBT is designed as self-help treatment with gives the patient more control and better chances at fighting chronic pain in future.
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