Using CBT to manage pain
Perhaps the title of this blog made you do a double take! But psychological therapies including CBT are recommended by the NHS and NICE (the National Institute for Health and Care Excellence) as a way of helping to manage chronic pain.
To understand how, it’s useful to look at what pain is. The International Association for the Study of Pain describes it as ‘An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’. Pain is ‘chronic’ when symptoms have lasted for more than three months, according to NICE.
The mention of the emotional aspect of pain is really important. Pain is complex, and there’s much more to it than the underlying physical or physiological cause. If we think of ‘phantom’ pain, for example, where someone feels very real pain in a limb that’s been amputated, we can see the powerful influence our brain can have over how we experience pain. This means that working on the psychological side of pain can bring positive results.
Pain tends to influence our emotions and behaviour – and vice versa. If we feel anxious, worried, stressed or down about pain this can affect how we experience it, and even on the severity of the pain itself.
How people think about their pain, and what they believe about pain and illness in general, can have a major impact on their response to it. For example, you might believe you can’t do certain activities in case they cause pain. If these activities could improve your mental or physical health, avoiding them might make you feel worse. If on the other hand you believe that ‘giving in’ to pain is a sign of weakness, and decide to push through it, you could potentially overdo things, making the pain worse.
Our personalities can affect pain, too. A perfectionist might feel compelled to push themselves to finish something on their to-do list, and do it well, rather than being happy to do a ‘good enough’ job or complete half the task and finishing later when they feel better.
NICE provides guidelines for managing chronic pain that’s linked to specific conditions, and also for ‘chronic primary pain’ where there’s no underlying condition or the pain is out of proportion with an injury or disease. These guidelines include exercise and physical activities, acupuncture, and psychological therapy including CBT.
So how does CBT help people understand and cope with their pain?
If you decide to try CBT treatment, your therapist will work with you to think through the pain itself, your beliefs and behaviours around pain, and your focus of attention – whether you concentrate on your pain a lot or ignore it. The treatment will then look at whether any beliefs about pain need to be addressed, whether it would be helpful to change any behaviours, and whether a change in focus of attention might be useful.
Here's an example.
A classic vicious cycle can happen with pain. Someone may be having a ‘good day’ pain wise, and feel inspired to clean the house. They keep going and going, and when they’re done they’re really pleased with what they’ve achieved. However, the next day they wake up in agony, and find it extremely difficult to do even simple tasks like getting up and making coffee. This is known as the boom/boost cycle.
One CBT technique that can combat this is pacing. This is where you work out how long you can comfortably keep doing a particular task for. For example, how long can you spend hoovering without feeling too sore or tired? Note this down on at least three occasions, and on a mixture of good and bad days. Work out what the average time is, and stick to this every day. Finding a happy medium can help you to manage your pain and potentially allow you to do more of what’s important to you in the future.
CBT can also help to manage anxiety that’s related to experiencing pain. Some people find themselves worrying about why they’re in pain, what other people are thinking of them, and whether they’re doing too much or too little, for example. Challenging and addressing these worries can help people to feel a lot better – mentally, but also physically. You can find out more about how CBT works to treat anxiety here.
If you wish to seek CBT for the pain you are experiencing please check here to see if you are eligible.