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Cognitive behavioral therapy CBT offers effective, safer, alternative to opioids for chronic pain treatment. Rising use of opioid medications to treat chronic noncancer pain is a major contributor to opioid crisis. But despite the aggressive marketing and prescribing of these powerful painkillers, there has been little change in the amount and severity of pain.
CBT is an important alternative to opioids for treatment of chronic pain. The goal of CBT is to help patients change the way they think about and manage their pain. The idea is not that pain in the absence of tissue damage is all in your head but rather that all pain is in the head. Cognitive behavioral therapy helps patients understand that pain is a stressor and like other stressors, it is something they can be adapt to and cope with.
Interventions may include relaxation training, scheduling pleasant activities, cognitive restructuring, and guided exercise all in the context of an empathic and validating relationship with the therapist. These interventions have the potential to relieve pain intensity, improve the quality of life, and improve physical and emotional function.
Therapy helps the patient see that emotional and psychological factors influence perception of pain and behaviors that are associated with having pain. Therapy in place cognitive and behavioral strategies help patients to cope more successfully. CBT and other alternative approaches for chronic pain. Studies suggest that CBT has a top-down effect on pain control and perception of painful stimuli.
It can also normalize reductions in the brain’s gray matter volume, which are thought to result from the effects of chronic stress. Cognitive behavioral therapy is moderately effective in reducing pain scores, while avoiding or reducing the opioid risks of overuse, addiction, overdose, and death. It can be used as a standalone treatment; in combination with other treatments, including effective non-opioid medications; or as part of efforts to reduce the opioid doses required to control chronic pain.
CBT and other nondrug treatments are underused due to unfamiliarity, time pressure, patient demands, ease of prescribing medications, and low reimbursement rates. There is a need for a paradigm shift from a biomedical to a biopsychosocial model for effective pain treatment and prevention of opioid use disorder.
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