If you are a sufferer of low back pain, or sciatica, or indeed any long term chronic pain, the very last thing you want to hear is someone telling you that it’s all in your mind. No doubt you could quite easily throttle them as it’s you that has to live with this unending torture on a day to day basis. This pain is very real, so how can thought processes bring about back pain relief? Here’s where Cognitive Behavioural Therapy comes in and chronic pain sufferers should consider exploring this method as an avenue to back pain relief.
So what is Cognitive Behavioural Therapy and how can it help?
Over the recent couple of decades cognitive behavioural therapy (CBT) has become an accepted first line psychosocial treatment which can help patients to deal with chronic pain, including low back pain. CBT states that individuals –not the outside environment, create their own experiences, including pain. The theory behind CBT is that the process of changing the patient’s thoughts about their pain can bring about changes in how the body responds to that pain.
The sensation or perception of pain actually occurs in the brain, so the theory behind CBT works on the premise that the sufferer can change the perception of physical pain by controlling the thoughts and behaviours that feed it.
The patient cannot physically stop or alter the level of the pain, but with practice, he or she may become able to control how their brain deals with that pain. For example a negative thought such I can no longer do this activity anymore might be changed into a much more positive outlook along the lines of “I will do it again just like I used to do”
What the therapist will seek to do is to encourage the patient to focus his or her thoughts (Cognitive), and then focus on subsequent actions which to address (Behavioural). This process may take place over many sessions with the therapist seeking to help the patient to identify negative thoughts and feelings encountered during bouts of back pain. These CBT sessions would attempt to train the patient in how to convert this negativity into positive thoughts and actions, and to develop healthy thinking. This healthy thinking involves positive thoughts and calming your mind and body by using techniques such as yoga, massage, or imagery. Positive or healthy thinking helps to make you feel better, and feeling better reduces the pain perception.
This transition of negative to positive thought processes has been demonstrated to help in enabling the patient to better manage their pain, and change the way in which the patient’s body actually responds to the pain. So although the physical pain is still present, changing the patient’s mindset can alter and improve their ability to deal with it.
CBT can relieve pain in several ways. It transforms the way in which the patient perceives the pain. It changes the thought processes, emotions, and behaviours in relation to pain, helps to develop coping strategies, and puts the level of discomfort into an improved context. As a result the pain tends to interfere less with the patients quality of life enabling the patient to function better. In addition we can also alter the brain’s physical responses that tend to worsen pain. When we are in pain, this causes stress which can negatively affect the production of pain control chemicals like Norepinephrine and Serotonin, which are the body’s natural painkillers. CBT can therefore positively impact on the natural pain relief response.
CBT can also help the patient to become more active, which is important because regular, low-impact exercise, for example yoga, pilates, walking and swimming, can help to reduce back pain in the long term.
So how does CBT work in practice?
In order to effectively treat chronic pain, CBT is usually used in conjunction with other pain management treatment such as pain relief medications, physiotherapy, weight loss regimes, various massage techniques, or indeed surgery. In a lot of instances CBT is considered to be one of the more effective forms of treatment, having less risk or potential side effects than pain relief medications or invasive surgery.
CBT sessions can be carried out through a range of formats ie
- Individual sessions
- Group therapy with other patients addressing the same pain issues
- Self Help modules – usually in the form of a book from which assignments are carried out
- Computer program or App (CCBT)
Group and individual CBT sessions generally last between 30minutes and a hour over anything from six to twenty sessions
During the CBT sessions the therapist will work with the patient to break down their problems surrounding their pain into separate components ie their thoughts, physical feelings and actions. These would then be analysed jointly to determine which are unrealistic or negative and then analyse the effect they have on each other and the patient. The therapist and patient will then draw up an action plan to alter unhelpful or negative thought patterns and behaviours.
The challenge then for the patient to practice the application of these changes in their daily life and provide feedback at the next session, with the objective being to teach the patient the application of these skills during the CBT sessions to daily life. By doing this the patient is learning to manage their issues or problems to prevent or reduce the negative impact on their life, and to carry this on after the CBT has been completed.
To summarise cognitive behavioural therapy involves
- Developing a positive or problem solving attitude in the patient to reduce the snese of helplessness over their pain and giving them a sense of control
- The patient carrying out homework or assignments designed to keep track of thoughts or feelings associated with pain and recording these for review
- Developing life skills and coping mechanisms for not only in pain control but in other problems encountered in life such as stress or anxiety
- Self help for pain management.
How to benefit from CBT for pain control
Have faith in the concept. There are many research papers demonstrating its effectiveness in assisting pain relief or pain reduction so its important to engage with the process
Actively engage with the concept. You have to put the effort in to get a positive outcome from the sessions
Ensure that you finish all the modules. For CBT to be effective its important to attend each session and complete all the assignments given to you. Indeed one of the major drawbacks of CBT is that of patient non compliance. Ie skimping or not bothering with all the elements of the CBT program
Be open minded about the possibility that CBT could work for you, but it does need your full commitment.
If you are interested in trying CBT for pain management, talk to your GP or healthcare professional in the first instance. They can point you in the direction of cognitive behavioural therapists specializing in back pain available in the UK through the NHS although there are likely to be waiting lists.
If you wish to have CBT privately then ask your GP to recommend, or alternatively contact the British Association for Behavioural and Cognitive Psychotherapies (BABCP) who will be able to provide details of accredited CBT practitioners.
If you want read more on CBT research there is an extensive paper on :-
Dawn M Ebde, Tiara M Dilworth, and Judith A Turner University of Washington