Chronic pain is a debilitating condition that affects over 1 billion people worldwide. It can be from aging, an injury, arthritis, cancer or any illness that impacts the central nervous system. Medical professionals define chronic pain as pain that continues to happen for three months or more, even when treatment is rendered. Many studies have shown that chronic pain will negatively impact social activities, personal relationships, and even employment.
In the short term, pain after surgery or an injury is often treated with opioid medications. However, with the rates of drug abuse and overdoses on the rise many doctors, and patients alike, are hesitant to use narcotics because of the risk of dependence. Chemically, many pain medications are similar to heroin, which is also an opioid. There is a risk that overprescribing opioid medications can lead to heroin use when the medications are discontinued but the patient has become dependent. The American Society of Addiction Medicine reported that in 2015 there were over 52,000 deaths from drug overdoses. About 20,000 of those overdoses were from prescription painkillers, and nearly 13,000 were from heroin.
One therapy for chronic pain that is often ignored is cognitive behavioral therapy or CBT. In an article published in the Journal of Psychiatric Practice, Drs. Muhammad Hassan Majeed of Natchaug Hospital and Donna M. Sudak of Drexel University College of Medicine, make a case for CBT as a treatment for chronic pain. While painkillers do alleviate pain, for the long-term, the authors point out, "There is no evidence that supports the use of opioids for the treatment of chronic pain for more than one year, and chronic use increases the serious risks of misuse, abuse, addiction, overdose, and death."
Part of the reason CBT isn't always considered is patient reluctance. Pain is unpleasant, and many patients don't want to risk losing the relief drugs can provide. Sometimes there are insurance issues as well since most insurance companies will cover prescription medication but many do not offer coverage for mental health services like CBT. There is a time factor as well. A patient who takes a pill for pain relief gets immediate relief. CBT takes longer, and many patients don't have a high level of confidence in it.
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Many patients who have chronic pain do not have tissue damage or other injuries or conditions. The pain is real, but the cause of it is likely related to chemical and electrical signals from the brain to the nerves. In patients like this, CBT could be helpful because the goal is to change the way patients perceive pain. In changing how a patient feels about pain and reacts to it, the brain can reset, in a way, and that adjustment can lower pain scores. They explain the emotional part of chronic pain, writing, "Therapy helps the patient see that emotional and psychological factors influence perception of pain and behaviors that are associated with having pain. Therapy...puts in place cognitive and behavioral strategies to help patients cope more successfully."
The article cites several clinical studies that support the use of CBT for chronic pain. Some have even shown that after CBT the volume in the brain's grey matter, which shrinks in reaction to stress, comes back up to near normal levels.
The authors sum up the situation with their conclusion, "There is a need for a paradigm shift from a biomedical to a biopsychosocial model for effective pain treatment and prevention of opioid use disorder. Increased use of CBT as an alternative to opioids may help to ease the clinical, financial, and social burden of pain disorders on society." The video below, while not from these authors, explains the use of CBT for patients with chronic pain.
Sources: Journal of Psychiatric Practice, Psychology Today, Clinical Pain Advisor
