For a lot of people CBT is kind of this buzz word that's out there floating around with vague associations. What does CBT treatment actually look like for a real life pain patient, or what should it look like?
There is no magical cure for pain, and everybody listening already knows that. If there was a magic pill we would all be taking it. There is no magical treatment. However, cognitive behavioral therapy is this much stigmatized and often ignored treatment for pain that has abundant evidence of effectiveness. It's what I practice, it's what I've used, and it has totally changed my life personally and professionally.
Cognitive behavioral therapy to me at first sounded like voodoo for pain. I thought, “What is this thing? It’s this psychological, bio-behavioral treatment and my pain is real.” And that's the number one thing I hear from my patients by the way - “My pain is organic. My pain is real. My pain originated from an injury or post surgery or cancer.” That’s such an important point for me to emphasize, because all pain is real. It doesn't matter if it was surgery or chronic illness, all the pain is real.
However, the problem with pain, and one of the things that’s just not talked about enough, is the fact that pain is not ever a purely biomedical process. Pain is not a thing that is exclusively about the body and it cannot be treated, especially chronic pain, by only focusing on the body.
If we’re only ever focusing on the back or on the knee, we’re missing the pain problem. Pain is this phenomenon that we actually call a biopsychosocial problem. The reason I like that word is because it really encompasses these three domains of pain that we actually need to target before we’re going to get well. And those are the three domains that are targeted by CBT. One is the biological or biomedical domain. Those are the things that we commonly talk about: tissue damage or system dysfunction or anatomical issues. Sleep and nutrition also fall into that category. Then there's the psychosocial domain of pain which is equally as important.
If we imagine that there's a Venn diagram - we’ve got biology, psychology and social functioning, those are our three domains - in the middle is actually where we have pain. If we're skipping cognitive and emotional and behavioral components, and if we’re skipping social or sociological or environmental components of pain, we’re really missing two-thirds of the pain problem.
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