Cognitive behavioral therapy for back pain

Cognitive behavioral therapy (CBT) can help many people deal with chronic pain.

What is CBT?

CBT is a form of psychological therapy. It most often involves 10 to 20 meetings with a therapist. Focusing on your thoughts makes up the cognitive part of CBT. Focusing on your actions are the behavioral part.

First, your therapist helps you recognize the negative feelings and thoughts that occur when you have back pain. Then your therapist teaches you how to change those into helpful thoughts and healthy actions. Changing your thoughts from negative to positive can help you manage your pain.

How Does CBT Work?

It is believed that changing your thoughts about pain can change how your body responds to pain.

You may not be able to stop physical pain from happening. But, with practice, you can control how your mind manages the pain. An example is changing a negative thought, such as "I cannot do anything anymore," to a more positive thought, such as "I dealt with this before and I can do it again."

A therapist using CBT will help you learn to:

Identify negative thoughts
Stop negative thoughts
Practice using positive thoughts
Develop healthy thinking

Healthy thinking involves positive thoughts and calming your mind and body by using techniques such as yoga, massage, or imagery. Healthy thinking makes you feel better, and feeling better reduces pain.

CBT can also teach you to become more active. This is important because regular, low-impact exercise, such as walking and swimming, can help reduce back pain over the long run.

For CBT to help reduce pain, your treatment goals need to be realistic and your treatment should be done in steps. For example, your goals may be to see friends more and start exercising. It is realistic to see one or two friends at first and take short walks, maybe just down the block. It is not realistic to reconnect with all of your friends all at once and walk 3 miles (5 kilometers) at once on your first outing. Exercise can help you to deal with chronic pain issues.

Getting Started

Ask your health care provider for the names of a few therapists and see which ones are covered by your insurance.

Contact 2 to 3 of the therapists and interview them on the phone. Ask them about their experience with using CBT to manage chronic back pain. If you do not like the first therapist you speak to or see, try someone else.

Alternative Names

Nonspecific back pain - cognitive behavioral; Backache - chronic - cognitive behavioral; Lumbar pain - chronic - cognitive behavioral; Pain - back - chronic - cognitive behavioral; Chronic back pain - low - cognitive behavioral

References

Cohen SP, Raja SN. Pain. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 30.

Henschke N, Ostelo RW, van Tulder MW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;(7):CD002014. PMID: 20614428 www.ncbi.nlm.nih.gov/pubmed/20614428.

Turk DC. Psychosocial aspects of chronic pain. In: Benzon HT, Rathmell JP, Wu CL, Turk DC, Argoff CE, Hurley RW, eds. Practical Management of Pain. 5th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 12.

Review Date 9/7/2017

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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