Cognitive Behavioural Therapy for Chronic Non-Cancer Pain: A Review of Clinical Effectiveness [Internet]

Excerpt

Chronic pain can be defined as ongoing pain lasting longer than expected, usually more than three months. It was estimated that 18.9% of Canadians aged 18 years and over were affected by chronic pain in 2011. Chronic pain is more prevalent among the elderly than younger populations. Half of chronic pain patients have suffered for more than 10 years. A third of the patients consider their pain very severe. Chronic pain most commonly occurs at the lower back and is due to arthritis. Canadian guidelines recommend medications for chronic non-cancer pain, but the management strategies vary depending on the sites, durations, and causes of chronic pain. Medications recommended for moderate to severe pain include analgesics and opioids. However, some medications have been linked to abuse and adverse events. For severe cases of chronic pain, a combination of psychological, behavioural, and physical interventions, such as cognitive behavioural therapy, are recommended with or without pharmaceutical interventions.

Cognitive behavioural therapy programs include cognitive and behavioural strategies to reduce pain and improve quality of life. Cognitive approaches include hypnosis, cognitive coping skills, stress management, and guided imagery. Behavioural approaches include biofeedback, relaxation training, and behavioural management programmes. The elements of these two types of approaches can be adopted for a cognitive behavioural therapy program. In Canada, publicly funded cognitive behavioural therapy is rare and the effectiveness of cognitive behavioural therapy programs remains unclear. This report aims to review the clinical effectiveness of cognitive behavioural therapy for chronic non-cancer pain.