News & Research Archive — Click here for a history of past Research in 2008 or 2007

About a third of the Addiction-Free Pain Management® System includes cognitive behavioral therapy (CBT) interventions. To give you an overview of CBT for chronic pain management I want to include excerpts from a report by Shannon Erstad, MBA/MPH. You can review her entire report that includes a great PDF Download Here.

Cognitive-behavioral therapy (CBT) teaches relaxation techniques, stress management, and other ways to help you cope with pain. Physical, psychological, and social factors all play a role in pain management.

Cognitive-behavioral therapy is based on the idea that thought and behavior patterns can affect symptoms and disability and may be obstacles to recovery. For example, when you feel a familiar type of pain starting or getting worse, you probably have a sense of how it will progress. If you are used to the pain being severe or long-lasting, you may expect the pain to become more intense. This thinking may make you feel out of control or helpless. A stress response like this can trigger physical changes in your body, such as a rise in blood pressure, the release of stress hormones, muscle tension, and more pain.

CBT can be helpful for chronic pain by changing the way you think about pain. It also teaches you how to become more active. This helps, because pain can also improve with appropriate physical activity, such as walking or swimming.

I also want to provide excerpts from a review by Vikas Garg, M.D., MSA that speaks to the efficacy of utilizing CBT for pain management. You can read the entire review Here.

Cognitive behavioral therapy (CBT) is a type of therapy in which patients identify negative thought patterns and replace them with positive ones. It combines techniques used in behavioral therapy and in cognitive therapy. It is based on the principle that a person’s beliefs about pain can influence adjustment to the pain experience. Unlike typical forms of psychotherapy, cognitive behavioral therapy focuses on present and future thoughts and behaviors, not past conflicts. CBT is usually short-term, whereas traditional psychotherapy is often long-term.

CBT is used to treat a variety of mental disorders but is also used to treat pain patients, particularly those experiencing chronic pain. Conditions for which CBT is sometimes prescribed include arthritis, back pain, headaches, insomnia, fibromyalgia, lupus, chronic fatigue syndrome, sickle cell anemia and some types of chest pain, abdominal pain and pelvic pain.

CBT is sometimes used when patients with pain conditions do not respond to other types of treatment, such as physical therapy or medications. It may also be used in conjunction with such treatments. Potential benefits of CBT include decreased psychological distress, better pain management and improved quality of life.

As mentioned above, two conditions that have shown significant benefit from including CBT interventions are chronic fatigue syndrome and fibromyalgia. I found the following information on the NaturalNews.com Website where you can read the entire citing.

Research has shown that Cognitive Behavioral Therapy (CBT) may improve life quality and symptom management for people with Chronic Fatigue (CFS) and Fibromyalgia (FM). Whilst it is not a cure for pain and fatigue, it can be tremendously beneficial in helping people deal with and manage their illness.

Studies reveal that when people who have CFS and FM feel in control of their health and life, their overall wellbeing improves. This is the aim of CBT. There is never a guarantee, but CBT has been shown to be incredibly effective at helping many people with Chronic Fatigue and Fibromyalgia to feel better about themselves, their illness, and life in general.

Each month I post three news and research type articles that usually focus on how to obtain better outcomes for chronic pain management. I have always been an advocate of using a team approach so in this article I want to build the case for utilizing a multidisciplinary approach to chronic pain management.

One source I came upon was the American Chronic Pain Association. On their website I found an interesting article supporting a multidisciplinary approach. Below I am including some information from that article. If you want to see the entire posting, check out their Website.

A multidisciplinary pain program can provide you with the necessary skills, medical intervention, and direction to effectively cope with chronic pain. Here is advice on how to locate a pain management program in your area, what to look for in a well-defined pain program, and what other issues to consider.

Consumer Guidelines to Selecting a Pain Program

Make sure you locate a legitimate program

• Hospitals and rehabilitation centers are more likely to offer comprehensive treatment than are "stand alone" programs.

• Facilities that offer pain management should include several specific components, listed below.

• The Commission on Accreditation of Rehabilitation Facilities [telephone: (800) 281-6531] can provide you with a listing of accredited pain programs in your area (your health insurance may require that the unit be CARF accredited in order for you to receive reimbursement). You can also contact the American Pain Society , an organization for health care providers, at (847) 375-4715 additional information about pain units in your area.

Choose a good program that is convenient for you and your family

• Most pain management programs are part of a hospital or rehabilitation center. The program should be housed in a separate unit designed for pain management.

• Many pain management programs do not offer inpatient care. Choosing a program close to your home will enable you to commute to the program each day.

Make sure the program includes most of the following features

• Biofeedback training
• Group therapy
• Counseling
• Occupational therapy
• Family counseling
• Assertiveness training
• TENS units
• Regional anesthesia (nerve blocks)
• Physical therapy (exercise and body mechanics training, not massage, whirlpool, etc.)
• Relaxation training and stress management
• Educational program covering medications and other aspects of pain and its management
• Aftercare (follow-up support once you have left the unit)

Desirable Characteristics of Multidisciplinary Pain Clinics

• A multidisciplinary pain clinic (MPC) should have on its staff a variety of health care providers capable of assessing and treating physical, psychosocial, medical, vocational and social aspects of chronic pain. These can include physicians, nurses, psychologists, physical therapists, occupational therapists, vocational counselors, social workers and any other type of health care professional who can make a contribution to patient diagnosis or treatment.

• At least three medical specialties should be represented on the staff of a multidisciplinary pain clinic. If one of the physicians is not a psychiatrist, physicians from two specialties and a clinical psychologist are the minimum required. A multidisciplinary pain clinic must be able to assess and treat both the physical and the psychosocial aspects of a patient's complaints. The need for other types of health care providers should be determined on the basis of the population served by the MPC.

• The health care professionals should communicate with each other on a regular basis both about individual patients and the programs which are offered in the pain treatment facility.

• There should be a Director or Coordinator of the MPC. He or she needs not be a physician, but if not, there should be a Director of Medical Services who will be responsible for monitoring of the medical services provided.

• The MPC should offer diagnostic and therapeutic services which include medication management, referral for appropriate medical consultation, review of prior medical records and diagnostic tests, physical examination, psychological assessment and treatment, physical therapy, vocational assessment and counseling and other facilities as appropriate.

• The MPC should have a designated space for its activities. The MPC should include facilities for inpatient services and outpatient services.

• The MPC should maintain records on its patients so as to be able to assess individual treatment outcomes and to evaluate overall program effectiveness.

• The MPC should have adequate support staff to carry out its activities.

• Health care providers active in a MPC should have appropriate knowledge of both the basic sciences and clinical practices relevant to chronic pain patients.

• The MPC should have a medically trained professional available to deal with patient referrals and emergencies.

• All health care providers in an MPC should be appropriately licensed in the country or state in which they practice.

• The MPC should be able to deal with a wide variety of chronic pain patients, including those with pain due to cancer and pain due to other diseases.

• An MPC should establish protocols for patient management and assess their efficacy periodically.

• An MPC should see an adequate number and variety of patients for its professional staff to maintain their skills in diagnosis and treatment.

Many people experiencing frequent headaches, especially migraines, don’t realize that the medication they use to help them can actually be increasing the frequency and even severity of their pain. I found an interesting report on the Medscape Website entitled “Barbiturates and Opiates Increase Risk for Chronic Migraine” December 4, 2008, by their news author Allison Gandey. I highly recommend this website both for information and CMEs (Continuing Medical Education). I’m including some excerpts from this report below.

Treating headaches with narcotics and barbiturates increases the risk for the development of chronic migraine. A new study shows that transformed migraine develops at a rate of 2.5% per year and that any use of barbiturates and opiates increases this risk.

"These treatments probably should not be considered first choice to relieve pain," senior author Richard B. Lipton, MD, from the Albert Einstein College of Medicine, in Bronx, New York, told Medscape Neurology & Neurosurgery. "They may offer some relief on a short-term basis, but there could be long-term negative consequences." Dr. Lipton said he expected to see an increased risk with narcotics in this study. "It was not completely surprising," he noted. "But the clear-cut dose response that we saw did make me gasp a little."

The findings appear in the September [2008] issue of the journal Headache. The initiative is part of the American Migraine Prevalence and Prevention study.

Narcotics Should Not Be Considered First Choice for Pain Relief

Investigators surveyed 120,000 individuals to identify a sample of patients with migraine to be followed up annually for 5 years. They studied more than 8200 patients with episodic migraine.

Using logistic and linear regression, researchers modeled the probability that patients would transition from episodic to transformed migraine in relationship to medication use. They made adjustments for sex, headache frequency, severity, and use of prevention medication.

Dr. Lipton and his team found that baseline headache frequency was a risk factor for transformed migraine. Using acetaminophen as the reference group, researchers found that patients who used medications containing barbiturates or opiates were at increased risk for transformed migraine.

However, use of triptans at baseline was not associated with the prospective risk for chronic migraine, the researchers suggest, and overall, nonsteroidal anti-inflammatory drugs (NSAIDs) were not associated with chronic migraine either.

"Indeed," they write, "NSAIDs were protective against transition to transformed migraine at low to moderate monthly headache days, but were associated with increased risk of transition at high levels of monthly headache days."

Migraines are divided into 2 groups: episodic and chronic migraines or transformed migraines. Episodic migraines refer to attacks occurring less than 15 days per month, whereas chronic or transformed migraines refer to headaches occurring more than 15 days per month.

Results demonstrated that any use of barbiturates and opiates was associated with an increased risk for transformed migraine after adjusting for covariates, whereas triptans were not associated with an increased risk for transformed migraine. NSAIDs had a protective effect against transformed migraine or they were inducers, depending on the frequency of the headache.

News & Research Archive — Click here for a history of past Research in 2008 or 2007