Behavioral interventions

The primary goal of behavioral interventions for pain is to increase healthy behaviors in patients (e.g., exercise) and decrease pain behaviors (e.g., avoidance of daily activities).

In certain cases, the behavioral therapist may seek to enlist the cooperation of the family.  Why?  Because family members may, unintentionally, reinforce pain behaviors, such as by taking over the patient’s chores, thus delaying recovery.

Another goal of behavioral treatments is to get patients to take medications at fixed intervals (as much as possible), instead of only in response to pain.  This helps reduce habituation and dependence on pain medications.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) focuses not only on changing pain behaviors, as do behavioral interventions, but also on changing pain-related thoughts. 

Indeed, much of the work involves monitoring and challenging one’s thinking regarding pain, like learning how to identify thinking errors (e.g., catastrophic thinking about pain).  Why?  Because mental distortions often worsen the experience of pain and cause dysfunctional behaviors, such as avoidance of daily activities or over-reliance on medications.

A vital part of CBT is homework.  Homework gives patients a chance to practice, in the real world, what they have learned in therapy, be it the logical skills involved in challenging erroneous thoughts, assertiveness, problem-solving skills, etc.

Acceptance-based chronic pain treatments

Acceptance-based interventions encourage individuals to identify activities that make their lives meaningful and to pursue these activities (despite the pain).

Compared to CBT’s emphasis on challenging erroneous thoughts as a way to motivate behavior change, acceptance-based treatments aim to disconnect thoughts and emotions from behaviors.  This means acknowledging the pain without allowing unpleasant thoughts and emotions to stop one from living a meaningful life.

To illustrate, a person with joint pain might decide against going for a short walking only because of a passing thought that walking could cause severe joint damage.  Through therapy, this individual would learn not to react strongly to such thoughts, not allowing them to dictate his or her behavior.

Relaxation, biofeedback, and hypnosis

Let us end with a brief description of three alternative treatments for pain: Relaxation, hypnosis, and biofeedback.

Relaxation training emphasizes awareness of bodily reactions to pain. And it uses various techniques for tension reduction.  For better results, relaxation is sometimes coupled with guided imagery (e.g., imagining relaxing in a peaceful place). 

Another treatment, called biofeedback, is particularly effective in cases where a dysregulated nervous system is a major contributor to chronic pain treatment. Through regular use of biofeedback equipment that measures physiological responses (e.g., muscle tension), patients learn to control their bodily responses to pain.

Last, hypnosis involves the use of focused attention and imagination to alter one’s experience and response to pain.  Patients could also learn how to perform self-hypnosis, which would be helpful for managing pain symptoms outside the session.