Behavioural Approaches to Pain Management

Cognitive Behavioural Therapy (CBT)

Whether evaluating or treating acute or chronic pain, pain management should include a biopsychosocial approach. Assessment may include focused joint and functional assessments including multiple global areas of impairment (i.e. gait balance and endurance) and disability.[1]

Cognitive behavioral therapy (CBT) can be described as the gold standard psychotherapy for individuals with a wide range of pain disorders. It can be used alone or in combination with various medical or pharmacological treatments.[2]

Chronic pain stands out as the most common condition treated with CBT. The reason for this as defined by the Institute of Medicine[3] is that chronic pain is a condition that is influenced by biological psychological and lifestyle factors and is effectively managed by non-alone therapies natural causes but also its psychological and social effects and consequences.[2] Since the introduction of the biopsychosocial model, the treatment of chronic pain has become multi-modal and multidisciplinary with emphasis on strategies aimed at maximizing the effectiveness of pain relief quality of life related to health care independence and mobility that promotes psychological well-being and prevents secondary activity.[4]

Over time, a patient in pain may develop behaviors such as pain panic (exacerbation of the threat of thinking about pain and perceived pain intolerance) and fear-avoidance (avoidance of activity out of fear a fear of increased pain or because of bodily injury) has developed . which has always been done it is found to be associated with significant physical and psychosocial impairment even after controlling for levels of pain and depression.[5][6][7][8] Individuals suffering from chronic pain may experience psychological anxiety and sleep disorders and CBT may also be used to treat these conditions.[2]

CBT in Practice

There is no standardized protocol for CBT; the number of sessions and the specific methods used vary. CBT for pain often includes relaxation training programs and working toward behavioral goals such as increasing physical activity and other activities behavioral activity guidance in activity pacing problem solving training and cognitive restructuring.[2]

CBT is currently the psychological treatment available for individuals with chronic pain such as back pain headache arthritis orofacial pain and fibromyalgia. CBT has also been used for pain associated with cancer and its treatment.[2] Although there is no combination of treatments psychophysical therapies seem to offer significant benefits. If pain persists after all treatment as in chronic pain, the issues are even more complicated. A person with pain primarily around movement tends to avoid doing things that stimulate them symptoms and choose to rest. Rest is not a helpful treatment because it causes secondary stiffness and weakness that exacerbates the symptoms the person is trying to avoid and makes them ineffective. Being unable to work leads to loss of function and self-esteem in other problems such as financial hardship and intimacy are slowly developing. Essentially, CBT techniques aim to improve the way an individual manages and copes with their pain rather than finding a natural solution to the perceived illness. If proper instruction is provided in a range of pacing techniques cognitive therapy to help identify negative thoughts and effective challenges to stretching and exercising to improve motor function careful planning of tasks and daily activities and widely recognized judicious recreational training CBT allows them to regain control over their lives to do more and feel better.[9]

CBT is usually addressed by psychologists, but practitioners such as physical therapists, occupational therapists, nurses, and doctors must improve their psychological understanding and skills in order to contribute to CBT. For example, an exercise program administered by a physical therapist will employ cognitive Determine the approach by identifying the person’s fears and beliefs about the sport or activity they are doing. Often this would indicate that the person’s caution is linked to a fear of harm. This method will allow the person to move in one way both physically and mentally Coercion alone can never be achieved. [9]

Cognitive Functional Therapy (CFT)

Cognitive Functional Therapy (CFT) is a multilevel, client-centered clinical reasoning management approach that addresses the beliefs, fears and associated behaviors (including exercise and lifestyle) of each back pain patient. [10] This approach focuses on changing the beliefs the patient faces Their fear allows them to understand pain mechanisms, increase mindfulness of body control during pain-provoking functional tasks, train them to reduce excessive trunk muscle activity and modify behaviors related to pain-provoking movements and postures. [11]

• It brings home the realization that pain is not a reflection of injury – but rather a process by which a person is caught in a vicious cycle of pain and disability. [11]
• It is strongly behavior-oriented and uses visual feedback to explore different movement options so that people rebuild their body schema and relearn the basic components of effortless normal movement.
• It enables people to do things they fear and/or avoid in a gradually relaxed and normal way.
• It conditions them if they are weak.
• It motivates them to exercise and live an active life according to their preferences and goals. [10]

[12]

This approach is well suited to the management of chronic disease as it aims to build self-efficacy, confidence and resilience, while providing pain sufferers with hope and opportunity for change in a person-centred manner. [10]

CFT in Practice

CFT interventions consist of comprehensive one-on-one interviews that include hearing the patient’s complete story about their pain, designed to meet the individual needs of the patient as well as the physical examination requirements of the treating physical therapist. this Patients are encouraged to discuss their level of fear of pain and any avoidance of work and social activities. Their beliefs and goals regarding managing their disease will then be identified. The physical examination includes analysis of the patient’s major functions Impairments (e.g., pain inducing fear and/or avoidance of movements and functional tasks) to identify maladaptive behaviors, including muscle conservation “abnormal” movement and postural avoidance patterns and pain behaviors. They will also assess their level Body control and awareness (body perception) and their ability to relax trunk muscles and normalize pain-stimulating postural and motor behaviors, and the impact of these on their pain. [11]

[13]

Therapeutic Neuroscience Education (TNE)

Traditional medicine is deeply rooted in the biomedical model, which assumes that injury and pain are the same problem. Therefore, increased pain means increased tissue damage, and increased tissue damage leads to more pain. This model (called the Cartesian pain model) is over 350 years old, and This is not correct. [14] Words like prominent hernia rupture and tear can increase anxiety and disinterest in returning to essential movement. This is especially important when the pain lasts for a long time. Most tissues in the human body heal between 3-6 months, but now We all know that persistent pain is more due to the sensitive nervous system. In other words, the body’s alarm system remains activated even after the tissue has healed. [14]

Over the past 10 years, a research team at the International Spine and Pain Institute and The Therapeutic Neuroscience Research Group has explored one such underlying cause and initiated various research projects aimed at learning more about pain. Understanding the biological process of pain is Called Neuroscience Education (Neuroscience). [14]

Therapeutic neuroscience education (TNE) has been shown to be effective in treating conditions primarily chronic musculoskeletal pain. [15] Emerging research shows how the nervous system/brain biologically and physiologically interprets their pain experience to patients Dealing with pain [16] enables them to produce some impressive immediate and long-term changes such as…  

• Decreased pain
• Improved function
• Diminished fear
• More positive thoughts about pain
• Increased pain knowledge
• Improved movement
• Improved muscle functioning
• Spend less money on medical tests and treatments
• Increased calmness of the brain (as shown by brain scans)
• Increased willingness to engage in much-needed exercise [14]

TNE in Practice

TNE alters the patient’s perception of pain. With TNE, patients learn that pain may not be an accurate representation of tissue health and may be more due to abnormal nerve sensitivity. Simply put, they know they may have a pain problem rather than a tissue problem. this neuroscience The view of sensitive nerves versus tissue damage allows for a new understandable perspective on treatments aimed at alleviating nerve sensitivity, such as aerobic exercise, manual therapy, relaxation, deep breathing, sleep, hygiene, diet, etc. [14]

A multidisciplinary approach to pain management utilizing multiple treatment modalities can benefit patients, healthcare providers, and society at large. Pain Management Including Behavioral Modification Therapy Can Significantly Improve Patients’ Chronic Pain Symptoms Reduce medication use and increase the likelihood of returning to work functional capacity patient care and patient satisfaction. These factors lead to lower healthcare costs. [4]