Chronic pain - Cognitive behavioural approach towards Pain

5 important questions on Chronic pain - Cognitive behavioural approach towards Pain

Which CBT techniques can be effective for treating patients with chronic pain?

  • Activity pacing
  • Cognitive restructuring
  • Exposure

How can you apply cognitive restructuring in the treatment of chronic pain patients?

  1. Identify maladaptive thoughts ("I exercise --> pain --> injury)
  2. examining the evidence ("why do I experience pain?")
  3. generate more adaptive thoughts ("I didn't use my muscles for a while, they need to get back in shape")

How can you apply exposure to feared activities in chronic pain?

Avoidance of behaviour is an important aspect that explains the persistence of pain and a maintaining factor for chronic pain.

Hurt your back --> certain movements are painfull -->restrict activities --> muscle weakening --> more activities cause pain--> more disability
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Out of what steps does problem solving exists as a CBT approach?

  1. Problem definition (what is the problem, what are obstacles?)
  2. generation of alternative solutions/strategies (how can I reach my goal?)
  3. decision making  (evaluating alternative solutions/choose an option)
  4. implementation and evaluation (monitoring outcomes)

How does relaxation directly and indirectly influence chronic pain?

  • Directly: catastrophic thoughts/fears --> increase the activity of the sympathetic nervous system -> increased muscle tone (tension) --> more pain
  • Indirectly --> diverting attention away from pain, being more relaxed, less impact of emotional distress on muscle tension

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