Last updated: May 06, 2008
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CBT teaches pain patients to replace negative thinking about pain with specific truthful statements.
(GRZEGORZ SLEMP/ISTOCKPHOTO/HEALTH)
Cognitive-behavioral therapy (CBT) can help pain patients end the downward spiral of negative thinking that worsens pain. People suffering from chronic pain can spend a lot of time thinking about it—projecting that it will render them useless and worthless, tear apart their family, or cost them their job. But proponents of CBT say that the technique can stop those thoughts in their tracks and actually alleviate pain.


"The irony is that the more you believe these frightening, catastrophic things are going to happen, the more anxious you become and the more your pain goes up," says Kimeron Hardin, PhD, a pain psychologist in the San Francisco Bay Area.

Change the Way You Think About Pain
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CBT helps patients identify negative thoughts and then change them. It sounds simple enough, but it takes hard work and time. Just recognizing your thoughts can be difficult, since they may be unconscious and automatic and even date to childhood.

The goal is to reframe the thoughts and change the pattern. "We teach them to be aware of the automatic thought patterns they have when they experience pain," says Robert Twillman, PhD, clinical associate professor of psychiatry at the University of Kansas Medical Center, in Kansas City, Mo.

An example of a negative thought pattern might be: "Oh, there's that pain again, I better lie down and stop what I'm doing, which makes me mad," says Twillman.

How to change it
Twillman says a patient can decide if the pain is terrible and life-destroying, "or they can decide, 'I have it, I can learn to live with it, and I'm not going to let it dominate me.'"

Be your own best friend
"Almost everyone has the ability to come up with rational statements when they're helping a friend who's upset," says Hardin. "What would you say to someone you really cared about who was starting to think catastrophically? You can teach yourself to take that perspective with your own thinking."

Coping cards for negative thinkers
One CBT technique involves writing down a negative thought on one side of a card. On the other side, write a rational comeback to that thought. When a destructive thought comes along, patients can reach for their card and repeat the coping statement to themselves. Francis Keefe, PhD, director of the Pain Prevention and Treatment Research Program at Duke University School of Medicine, in Durham, N.C., says they can be invaluable in creating new thought habits. "I can't tell you how many patients carry these cards around, they're absolutely dog-eared. People tell me that just having the card in their wallet makes them more aware of their tendency to think that way, and it helps them to know they have an option, a different way to think about the situation."