New Ways To Use Cognitive Behavioural Therapy For Pain

The statistics
According to the Australian Bureau of Statistics 16 percent of all Australians report back pain. This figure is in keeping with estimates that 10 – 15% of adults worldwide suffer from the condition. It’s a widespread problem that alters the way people go-about life with debilitating physical and psychological impacts.

Cognitive Behavioural Therapy for back pain
Because back pain is often instigated by multiple factors in the body and the mind, a single doctor can’t effectively heal the patient. But, with a multidisciplinary medical team there are noticeable improvements. Cognitive Behavioural Therapy is highly recommended to treat a patient psychologically, alongside other treatments, with say a GP and a physiotherapist (whatever is applicable to individual patients). Studies around the world have even begun trialling delivering CBT therapy electronically via the internet or phone.

Electronic delivery of CBT can be accessed at a patient’s convenience, reduces trips to the doctor, which is helpful for those living in remote locations or with busy schedules, and reduces pressure on the health system. Trials of electronic CBT are designed to empower patients to take an active role in their own recovery. But does it work?

A range of CBT trials delivered over the phone or online have shown it is possible to reduce catastrophising. This is a psychological term that describes how patients focus heavily on the doom and gloom about their condition which in turn exacerbates the physical pain they feel.

As you can imagine, knowing that you will feel experience pain every day and night is psychologically damaging. This stress is processed in the brain similarly to physical pain. It goes to reason that looking after a person’s psychological health can likewise improve physical symptoms. In this context the goal is to bring people’s beliefs about pain and their condition into alignment with what they’re experiencing in reality, instead of believing things are worse than what they are.

CBT studies delivered online and by phone
One study with 95 participants set up weekly, online CBT modules over 12 weeks, but the patients also received weekly phone calls around coping strategies as well as as physical exercises. Two months after the experiment the group were measurably better off because they catastrophised less.

Another study with 141 participants instructed patients to use an online CBT workbook for 3 weeks and after this time patients reported decreased pain, less catastrophising and a more positive outlook toward their disability or back pain. At the same time a control group had no access to the online workbook and at the end of the experiment they were less confident about their condition and were avoiding physical exercise.

A third study with 228 participants asked back pain sufferers to access a CBT website and supplemented this activity with a weekly chat moderated by a therapist. In follow ups 3 and 6 months after the experiment patients said they stress levels were lower, coping was greater but there was no effect on pain and physical function.   

The fourth study didn’t use a therapist over the phone, but an interactive voice recording and this likewise saw promising results. This therapy used technology similar to what you hear when calling a large service provider yet this time the questions that patients dialled through were geared around back pain. Results recorded 3 months later showed patients experienced reduced pain, better sleep and physical functioning.  

“Although online treatment is appealing for its convenience, there are certain psychological and medical conditions that need direct supervised medical management,” said Dr. Jatin Joshi, a pain and spine care researcher at Weill Cornell School of Medicine in New York. While these four studies demonstrate that electronic delivery of CBT can be effective for back pain doctors and therapists won’t be out of work anytime soon because a level of face-to-face care will always identify issues that just won’t be picked up by interaction over a telephone or computer.