CBT FOR CHRONIC PAIN – CBT CP

Developing a CBT treatment plan and short-term treatment.

CORE TARGETS OF CBT-CPExercise: Increased engagement in valued physical activitiesPacing: Activities that grow stamina/strength with in window of tolerance Relaxation Training: Development of skills to relax and reduce stressCognitive Restructuring: Changing ANTs, Challenging Core CogBehavioral Activation: Enhanced pleasurable and meaningful activitiesFunction and Values: Increased values based livingSleep and diet: Improving sleep and diet to address pain

PSYCHOLOGICAL FACTORS: PAIN COGNITIONS Pain cognitions are thoughts and beliefs that lead to increased suffering, increased pain perception/signal,

disability and maladaptive coping.

What are some common pain cognitions that could be dysfunctional?

PSYCHOLOGICAL FACTORS: OVERVIEW Catastrophizing: One of the core aspects of thoughts that lead to increased pain, ineffective pain coping, and increased distress. Suffering vs Pain: Suffering is the emotional response to pain. Pain is the specific sensation. Hurt versus Harm: Pain is supossed to be a signal of harm. In chronic pain, pain itself is a disease and no longer is a clear indication of harm. The ability to re-interprate pain as harmful vs hurtful can impact pain functioning.

PSYCHOLOGICAL FACTORS: OVERVIEW Negative Affect: Depression, Anxiety and Difficult emotions can happen when we are in intense pain. This can increase pain intensity, poor coping and acts like a volume knob turning up pain. Answer-Seeking: Difficulty accepting the ambiguity of a pain diagnosis and continuing to try to find an answer when acceptance and engagement w/ tx would help more. Often related to grief process. Pain Self-Efficacy: An adaptive belief that an individual has developed some ability to manage, accept and control the impact of pain on their life.

PSYCHOLOGICAL FACTORS: PAIN COGNITIONS

BEHAVIORAL FACTORS: CHRONIC PAIN Passive Coping: Coping that is passive in nature and relies passive strategies.

Guarding: Any postural attempts at management that include bracing, limping, protection of limbs. These can be unconscious, semi-conscious or conscious patterns used to protect an area that has been in pain.

Resting/Inactivity: Resting is vital for effective pain management. This can become the dominant strategy for pain management. If this happens it leads to deconditioning emotionally, physically and increased avoidance. What are some ways you can think of to help address

these strategies?

BEHAVIORAL FACTORS: CHRONIC PAIN Active Coping: Coping that is physically active in nature.

Exercise: This is a potentially positive activity that helps individuals increase tolerance for pain, increase conditioning and reduce overall pain levels?

Over Activity: Over activity can lead to feelings of overwhelm, giving up, increased pain and reduces the positive impact of pain interventions.

Can you explain why exercise helps with chronic pain?

PACING AND PAIN: BRAKING THE CYCLE

BEHAVIORAL FACTORS: CHRONIC PAIN Pacing: As previously mentioned, pacing is the practice of engaging in an appropriate level of physical activity without significantly exacerbating pain. By using calculated increases in activity, pacing can lead to greater endurance and a reduced frequency of intensely painful episodes. Relaxation Training: Relaxation techniques lead to decreased perceptions of pain and can contribute to feelings of self-efficacy to manage pain.

What are some ways you have found to provide effective relaxation training?

SOCIAL FACTORS: CHRONIC PAIN

Let’s generate a list of common social factors our patients face related to chronic pain

CASE CONCEPTUALIZATION REGGIE: Reggie is a 64-year-old, African-American male Vietnam Army Veteran with bilateral foot pain due to diabetic neuropathy. He also has joint pain in his knees and ankles. His primary care physician referred him for assistance with how he can better manage his pain. Reggie was diagnosed with diabetes 9 years ago but the painful tingling and numbness in his feet has worsened over the last 2 years. He is now mostly sedentary and spends most of his day watching television in his recliner. While he was overweight when diagnosed, he is now morbidly obese and has gained 30 pounds this year. His provider shared that Reggie has not taken his pain medications consistently, and has discontinued physical therapy after one session since it created increased pain. Reggie is frustrated and angry about his lack of mobility and need to use a rolling walker when walking long distances. He has been married for 35 years and describes his wife as an “angel;” however, he feels guilty that he is unable to help more around the house and with yard work, and reports that he “snaps” at her because of his pain. He wants to be able to play with his grandchildren and be more active with his church, but lately he has not even been attending services since it is too difficult to get going.

CBT-CP SESSION GUIDE: STEP BY STEP

Make Practice/Homework Plan

Problem Solve Skills in Life

Develop Skills/Education/Training

Develop and Agreed Agenda

Assess SUDS and Functioning

Assessment

Reconceptualization of Pain

Skills Development

Rehearsal of Skills

Enhance Maintenance

Follow Up and Relapse Prevention

TREATMENT ARC AND GOALS: CBT-CP