Use cognitive behavioural therapy to manage pain

Cognitive behavioural therapy is a treatment technique that aims to change the way you think about problems like pain. By changing your thoughts, you can also change how you perceive pain. We'll teach you more.

Sometimes the best way to learn about something is to see it in action. This case study illustrates how CBT works:

• Kate Muller, PsyD, director of the Cognitive Behaviour Therapy Program at Albert Einstein College of Medicine began seeing a woman in her late forties who complained of terrible joint and muscle pain, which resulted from treatments for hepatitis C. She woke up stiff, was tired by lunchtime, and was unable to work because of pain.
• Often, this patient would feel so bad when she woke up that she went back to bed, thinking "What's the point of getting up?"
• Even when something helped (like a warm shower), she responded by remembering that the soothing effects would quickly fade. She was haunted by guilt about letting her family down and angry that pain was eroding her relationships.
• When she did feel an energy boost, she raced around doing errands until she dropped.
• Muller responded by asking the woman to monitor her pain, noting both its intensity and whatever thoughts sprang into her head when she experienced it.
• The next session they worked together on coming up with more balanced statements that didn't involve judgments. For example, instead of thinking upon waking, "I hate this pain. The day is only going to go downhill from here," she might say "Let me do a body scan and see how I'm feeling now. Let's see if I can get out of bed."
• In three to four hour-long sessions, the woman's rating of her pain had decreased by 30 to 40 percent.
• What Muller's patient experienced is the essence of cognitive behavioural therapy (CBT), a therapy based on the belief that the thoughts and emotions people have about pain affect the pain itself and also influence the behaviours they use to address it.
• Numerous studies have proven cognitive behavioural therapy to be effective in addressing back pain, arthritis pain, and cancer-related pain, and in easing the sleeplessness that often accompanies pain.

How you think about your pain can affect whether it spends the night or packs up to go elsewhere. Here are a few examples of how to turn negative thoughts into thoughts that are positive but still realistic:

• Not helpful: Oh, here's my pain again. The day's only going to get worse from here.
  Helpful: Let's see how I'm feeling. How about if I get out of bed and give things a try?
• Not helpful: This shower feels great, but when I get out, my pain will start all over again.
  Helpful: This shower feels great. Maybe I'll feel well enough afterward to go shopping.
• Not helpful: My pain has ruined my life. I can't do anything.
  Helpful: My pain has changed my life. But because of it, I now take better care of myself. And I can still [fill in the blank].
• Not helpful: My family doesn't believe that I'm in pain, and they're angry that I don't do the things I used to. I'm really letting them down.
  Helpful: I'm doing the best I can. It's up to me to help my family better understand how my condition affects me.

CBT is a very powerful tool to manage a wide variety of physical and mental disorders. If you suffer from pain, chances are good that it can help. Speak with your doctor about starting CBT. Changing the way you think really does change the way you feel.