Chronic Pain and CBT: Effective Strategies for Relief
Cognitive behavioral therapy (CBT) is a type of therapy that gives patients the tools they need to reduce stress, improve mood, and be more active, which can help lessen chronic pain.
As a psychologist who works in a pain clinic, I am often asked, “Why would training my brain reduce my pain?” So, let’s talk about that. What does the brain have to do with pain?
Why we feel pain
First, the basics: All pain comes from the brain, no matter what is happening in the body. If you have a broken bone or burn your hand on a stove, your brain sends a pain signal to warn you. The health of the body is important, and your nerves play a key role in the pain process. The nerves detect problems in your body and send signals to your brain. Your brain receives these nerve signals, figures out what they mean, and then decides when to send you a pain alert.
Sometimes pain is useful. If we have a broken bone or an illness, pain keeps us safe by telling us something is wrong so that we can rest, let the body heal, or get medical treatment. This helpful pain is called acute pain. It shows up when we have an injury or illness, then goes away when the illness or injury is gone.
What is chronic pain?
If someone is sick for a long time, the brain can learn to send pain messages even if the illness or injury improves or goes away. We refer to this as chronic pain. It is like having a fire alarm: A fire alarm is good if it warns me that my house is on fire. But if that fire alarm goes off even after the fire is out, it is not helping me anymore. In that case, it’s causing a new problem.
A medical condition such as cancer may cause pain for a long time. This chronic pain may happen if the brain increases the pain messages that are already there. This is like turning up the volume knob on a speaker. We become more aware of it. In this case, chronic pain means the brain sends more pain messages than the body needs to stay safe. The pain is still real, but it does not help anymore.
"People do not choose to feel pain. Pain is something that the brain does automatically, just as our heart beats automatically or our digestive system breaks down the food we eat. Even though we do not choose to feel pain, we can do things to decrease it when it happens."
Protected by pain
It is important to understand that pain is your brain trying to protect you. Pain is not there to harm you or make your life worse. Your brain thinks you are in danger and uses an alarm to get your attention.
Although pain is an alarm, pain by itself cannot harm your body. For example, if a fire alarm goes off in your house, the alarm cannot damage the house. It can be hard to look at pain that way because it causes you a lot of stress and can make your life seem worse.
When the brain senses a threat, it will start sending more pain to protect you. This is why many people with pain report that some things make their pain worse, like stress or strong negative emotions such as sadness or anger. When people have chronic pain, their brain may be trying to decide if the body is safe or in danger.
People do not choose to feel pain. Pain is something that the brain does automatically, just as our heart beats automatically or our digestive system breaks down the food we eat. Even though we do not choose to feel pain, we can do things to decrease it when it happens.
Using cognitive-behavioral therapy to decrease pain
There are ways to train the brain to decrease your pain. These can include taking medications, exercising, doing physical movement, and using other ways to calm your brain and nervous system.
One common treatment that psychologists use for pain is called cognitive-behavioral therapy (CBT). CBT is a toolbox of different ways to reduce stress, improve your mood, and help you be more physically active. It can also help you with other problems that pain can cause, such as sleep problems.
Some techniques used in CBT include:
- Use relaxation techniques: Take slow, deep breaths, gently tense and relax muscles, or picture yourself in relaxing or pleasant situations to reduce stress on your brain and nervous system. These techniques work better if you practice them regularly.
- Talk back to automatic, stressful thoughts caused by pain: Thoughts such as, “This pain is never going to get better” or “My life will never be the same” can worsen your mood. Thinking this way can make it hard to stay motivated and can create more stress. You do not have to stop these thoughts from happening, but you can stop them from making life harder when they show up.
- Learn to move your body in safe ways: Physical activity is an important part of treating chronic pain, but many people with pain say that movement can be painful, especially at first. So, try to find ways to keep your body moving even if pain is there. If you have a lot of pain or pain most of the time, even small amounts of movement or very gentle movement can be a great place to start. Physical movement is an important way to reduce pain because it helps the body (and brain) get stronger and healthier.
- Improve your sleep: Pain can make it harder to get good sleep. Sleeping poorly can worsen the pain’s intensity.
- Improve your mood: Pain can cause high levels of depression, anxiety, and other negative emotions. Plan activities that are fun or rewarding to help increase your positive emotions. These activities help your brain break out of the pain/stress/threat cycle.
CBT and other therapy techniques do not replace medicine or other treatments. In fact, they work best when used along with other treatments. When it comes to pain, treating both the brain and body is the way to increase your chances that your pain will go away.
