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Cognitive behavioral therapy reduces pain

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The vast majority of people with chronic pain rely on pain medications like prescription opioids for relief, but as the use of these drugs has increased, so has the incidence of serious problems including overdose, addiction and health complications. 

Often pain killers don’t improve a person’s ability to function well (because they feel too sedated) or their quality of life, which should be the main goal in treating pain.

Most pain experts advocate a more comprehensive approach to managing pain including exercise and what’s known as cognitive behavioral therapy (CBT).  

CBT includes talk therapy to change the way you think about your pain as well as behavioral approaches that reduce stress, improve sleep and manage anxiety.

Now, a new study found that CBT is significantly more effective than standard care in treating people with body wide pain, like those with fibromyalgia. In the study, published in the January issue of the Archives of Internal Medicine, 442 patients with chronic body-wide pain, were randomized into one of four groups: one group received CBT over the phone; one group was  told to exercise 20 to 60 minutes a day, at least twice a week; one had CBT and exercise, and a control group that continued whatever treatments they were using.

In the group with the combined CBT and exercise intervention, 37 percent reported improvements in their general wellbeing after nine months, compared to only eight percent in the control group.  About 33 percent of those who only received CBT reported improvements and 24 percent of those who only exercised reported improvements.

CBT addresses factors that help reduce pain and help patients cope with pain symptoms. It’s short term therapy that can last as few as eight to 10 sessions. It includes a range of approaches including:

Behavioral activation. The main objective is to increase your activity levels by participating in positive and rewarding activities. People in pain tend to avoid activities because of fears, anxiety or depression.  

Cognitive restructuring. This approach helps people identify unhelpful patterns of thinking and negative thoughts, replacing them with more constructive ways of thinking. So if someone is saying to herself, “I’ll never get better,” a therapist might try to get her to stop catastrophizing her situation and take a more day by day approach. If you show signs of depression, you may be referred to a medical doctor for an antidepressant prescription. Many people with chronic pain suffer from depression and depression is known to worsen the pain.

Lifestyle changes. The therapist works with you to help improve your sleep (fatigue worsens pain) and teaches you relaxation techniques, which could include deep breathing, meditation or even biofeedback.  You’d also examine your diet and exercise habits. Exercise, though difficult I f you’re in pain, is one of the best ways to reduce your pain.
 

Laurie Tarkan is an award-winning health journalist whose work appears in the New York Times, among other national magazines and websites. She blogs about the Affordable Care Act for the WellBeeFile. Follow her on Twitter and Facebook.