Cognitive Therapy for Chronic Pain

Andrew L. Martin, Psy.D.
OSC Clinical Psychologist

Cognitive therapy for chronic pain is a 10-session, twice-weekly psychotherapy to reduce physical pain. Sessions last about one hour, in which the therapist teaches skills to change how the brain processes pain signals. Cognitive therapy for chronic pain has a 70% success rate. 70% of patients report that their pain reduces about as much as if they were taking a narcotic, report fewer pain flare-ups (where the pain gets really bad all of a sudden), less distress over whatever pain we have to live with, and being able to do more.

There are no risks associated with cognitive therapy for chronic pain. The most difficult part of the therapy is getting oneself to attend the next session and to complete skills training in between sessions. This difficulty has nothing to do with intelligence or motivation. It’s natural for the brain to avoid anything having to do with pain, and that unfortunately includes talking to a psychologist about reducing pain! In reality, once in session or practicing the skills at home, most people find the process interesting and helpful.

The human brain is designed for survival and avoidance of pain. This is very helpful in dealing with short-term, dangerous situations. It focuses our attention on threats and ramps up our nervous system so we can fight or run away. But when stress is constant, like with chronic pain, the nervous system stays ramped up all the time. This is a problem because a ramped-up nervous system becomes increasingly sensitive to pain over time. This means that people with chronic pain conditions experience more real pain from the same conditions than people whose pain is intermittent.

Over the last 2,000 years, humans have learned skills to improve the way the brain handles chronic pain. It began with mindfulness and meditation – simple techniques that force the nervous system to relax and be less sensitive to pain. Most recently, we learned to change thoughts that affect our stress and nervous system using a skill called cognitive restructuring. Cognitive restructuring involves learning to see unconscious thoughts that we all have in response to stress. This is important because those thoughts can impact the nervous system and therefore our pain. Once we learn to see those thoughts, we can learn to challenge them using a set of rules, and replace them with thoughts that have less negative impact on the nervous system and pain. Cognitive therapy for chronic pain includes these and several other techniques, all designed to put us more in control of our nervous system, and therefore more in control of how much pain we will experience.

Most psychologists can provide cognitive therapy for chronic pain. Health psychologists and pain psychologists specialize in this treatment.

REF: Thorn, B. E. (2017). Cognitive therapy for chronic pain: a step-by-step guide. Guilford Publications.