BACKGROUND: Psychological treatments are designed to treat pain, distress and disability, and are in common practice. This review updates and extends the 2009 version of this systematic review.
OBJECTIVES: To evaluate the effectiveness of psychological therapies for chronic pain (excluding headache) in adults, compared with treatment as usual, waiting list control, or placebo control, for pain, disability, mood and catastrophic thinking.
MAIN RESULTS: Overall there is an absence of evidence for behaviour therapy, except a small improvement in mood immediately following treatment when compared with an active control.
CBT has small positive effects on disability and catastrophising, but not on pain or mood, when compared with active controls.
CBT has small to moderate effects on pain, disability, mood and catastrophising immediately post-treatment when compared with treatment as usual/waiting list, but all except a small effect on mood had disappeared at follow-up.
I doubt this is a surprise to any pain patient: You can’t cure chronic pain just by thinking it away in therapy! While attention to and working on the psychological aspects of pain eases suffering, it’s not enough to defend against most chronic pain.
It’s been proven that chronic pain is associated with depression and anxiety, and some have seized upon this as “proof” that the pain is caused by psychological factors. From personal experience, I can say that it’s the other way around: chronic pain causes depression and anxiety. Treating physical pain with psychotherapy is ineffective when the pain itself is not physically addressed as well.
So often, we pain patients are accused of contributing to or indulging in our pain for “psychological” reasons. So many of are pressured to “fix our thinking” because others assume that if we can’t find and fix the physical problem, then it must be a mental problem. This is just another example of our warped cultural attitudes toward pain and disability (see my previous post “Breaking Bad” Reflects our Cultural View of Disability and Illness).
And another point:
Psychotherapy was not designed to be such a simplistic medical tool. Medicine is focused on curing physical pain by forcefully changing the body, while psychotherapy aims to ease emotional pain by teaching better coping skills. “Fixing” and “nurturing” are very different treatments, so tying to make quantitative comparisons seems almost silly.
The current focus on healthcare performance metrics is forcing rigid measurements upon a subjective practice, trying to measure quantity when the therapeutic goal is quality.