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Cognitive Behavioural Therapy

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Cognitive behavioural therapy (CBT) is a commonly used psychological intervention for chronic pain. Often used as a part of a more comprehensive pain management program, it attempts to modify beliefs and coping skills, particularly when these beliefs and coping skills are dysfunctional.

Table 13: Cognitive Behavioural Therapy

Discussion

Four studies examined the effectiveness of interdisciplinary pain management on chronic pain post SCI. Perry et al. (2010) placed SCI individuals with chronic pain into a multidisciplinary cognitive behavioural pain management program, involving pharmacological and CBT treatment, or in a usual care control group. This was the only study to find significant improvement in both the MPI and SF-12 MCS scores in the treatment group compared to the control group post treatment. A trend towards improved pain intensity and HADS score was also seen in the treatment group post treatment; however, scores returned to pre-treatment scores by 9 month follow-up. Norrbrink et al. (2006), Burns et al. (2013), and Heutink et al. (2012) found no improvement in pain intensity among individuals receiving treatment. However, both studies found significant improvement in related psychosocial factors post treatments. Norrbrink et al. (2006) found significant improvement in anxiety, depression and sleep interference post treatment. Burns et al. (2013) found change in life interference and locus of control. Significant improvement in anxiety and participation in activities was seen in Heutink et al. (2012) among individuals that received CBT.

Conclusions

There is level 2 evidence (from one prospective controlled trial; Perry et al. 2010) that a cognitive behavioural pain management program with pharmacological treatment may improve secondary outcomes among SCI individuals with chronic pain post SCI.

There is level 1b evidence (from one randomized controlled trial one prospective controlled trial, and one pre-post study; Heutink et al. 2012; Norrbrink et al. 2006; Burns et al. 2013) that cognitive-behavioural therapy alone does not change post-SCI pain intensity.

  • Cognitive behavioral therapy combined with pharmacological treatment may result in improvement in secondary outcomes among SCI individuals with chronic pain.

    Cognitive-behavioral pain management programs alone do not alter post-SCI pain.