• Monica Pandey

Cognitive Behavior Therapy for Pain Management

In the previous articles, the link between pain and psychology has been clearly established. People’s perception of events influences their emotion processing which in turn influences the way they experience pain. Cognitive Behavior therapy is a powerful and scientific tool propagated to alter thinking processes in order to change perceptions in favor of healthier ones that improve coping. The aim of this article is to enable understanding of cognitive behavior therapy and its application to the management of chronic pain.

The brain child of renowned psychiatrist, Dr Aaron Beck, Cognitive Behavior Therapy is in existence since 1960s. Dr Beck, in his work with several patients, found that those with depression had a continuous stream of negative thoughts about oneself, the world and the future, which he termed as cognitive triad. He called these thoughts, “Automatic Thoughts”. As a first part, he started helping patients focus on these negative thoughts, identify them and change them. This helped them successfully develop better thinking patterns towards the cognitive triad and, in turn, develop better coping mechanisms.



In the process of thought restructuring, he also identified underlying belief systems, which are ingrained into the subconscious mind of a person. These beliefs are formulated in our early years and are very deep-rooted. Thus, the thoughts are guided by the beliefs. In Cognitive Behavior Therapy, the therapist helps to restructure the belief systems to acquire more rational belief systems and thereby acquire healthier thoughts. Over the years, several studies have established the efficacy of this psychotherapy when applied to a variety of psychiatric, psychological as well medical problems, including pain management. When it comes to pain, patients often struggle with pain acceptance, fear avoidance, pain behaviors and the perception that they have limited control over their pain. CBT helps to rework these behaviors and assumptions.

Systematic Review of Psychological Treatments in Fibromyalgia is a study by María José Lami, María Pilar Martínez & Ana Isabel Sánchez published in 2013. Along with pain, fibromyalgia patients also reported other conditions such as anxiety, depression, fatigue, sleep disturbance, headaches etc. This study included 58 studies on psychological treatments for fibromyalgia. The findings were that CBT was found to be very effective in reducing distress symptoms associated with pain when combined with pharmacology.

More often than not, pain is perceived as a purely medical condition. Due to this, patients feel overwhelmed with the condition and perceive a total lack of control. CBT focuses on enabling the patient to live with pain while alleviating suffering. The treatment program focuses both on psycho education as well as rehabilitation. CBT provides patients the ability to acquire control over their thoughts, feelings and behaviors in response to pain. When the patients understand that they can control these, it leads to improved physical as well as emotional well-being. CBT identifies common thinking errors related to pain, for example, overgeneralization. A thought such as, “If this strategy has failed, none will work with me,” comes under the category of overgeneralization. The strength of CBT lies in the fact that it gets patients to reconceptualise the entire outlook towards pain. CBT is solution oriented thus patients are able to convert vague problems into well-defined, solvable ones.

There’s a famous saying by William Shakespeare, “There is nothing good or bad but thinking makes it so.” Thus, to summarize, CBT is a wonderful form of treatment for pain management, in conjunction with pharmacology, a treatment worth considering rather than letting the pain affect every aspect of life.

So, while you reflect upon this article and decide when to book a therapy session, here are some quick cognitive tips for you to start practicing.


  1. Start your day with a positive thought – Starting your day on a positive note is very important as it sets the tone for the rest of the day. Say a positive affirmation about the day or about yourself.

  2. Turn around a bad situation – As our perceptions shape our world, it is a good practice to find at least something good in the darkest of events. It helps improve our ability to deal with things beyond our control, and regain a sense of control.

  3. Practice positive self-talk – Engage in positive talk with oneself. It helps to keep negative thoughts at bay.

  4. Keep your circle positive –Avoid being around negative people. Remember, negativity breeds negativity.

  5. End the day with gratitude – A grateful heart goes a long way in being happy. So find something in the entire day to be grateful about and offer a thank you to the higher powers.

Try these easy tips. While these will help you greatly, do consider therapy! Remember, thoughts shape our world and with help, you can master them, so REACH OUT!

I leave you with that thought and welcome your comments on the same.





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