CBT for Pain Control


We’ve known for years that high doses of pain-relieving nonsteroidal anti-inflammatory drugs, or NSAIDs, can increase the risk of heart attack, stroke, and gastrointestinal damage.

Yet the Anacins, Bayers, Bufferins, Excedrins, Advils, and Motrins continue to fly off the shelves. Between over-the-counter (OTC) sales and roughly 70 million prescriptions written, nearly 30 billion doses of NSAIDs are downed in the US each year.

New research shows it’s not just high doses that put you at risk of dangerous side effects. And it’s not just people with a history of cardiovascular problems who are at risk. It’s not just longtime users and not just older users.

My take? Everyone’s at risk. NSAIDs are meant to relieve episodic acute pain relief – for short periods of time. They’re not meant for the chronic pain complaints for which they’re routinely prescribed or grabbed OTC. And these recent findings make these all-too-common drugs even scarier: Even younger NSAID users, with no past cardio or gastro issues, show increased risks of dangerous side-effects compared to non-users.

Even the ever-slow FDA has updated its warnings about NSAID use. The bottom line? NSAID use increases the risk of heart failure, heart attack, and stroke. That risk starts as soon as you start taking them, and it increases the longer you do and if you increase the amount you take.

I know a much better way to manage chronic pain. It’s drug-free and it works.

What is cognitive behavior therapy (CBT)?

I’m a resolute believer in mind-body integration—how the body reacts to changes in the mind and how the mind reacts to changes in the physical body.

Cognitive behavior therapy works on this principal: mind affects body, and body affects mind. As a therapy, it’s all about recognizing the specific mental stimuli that lead to whatever symptom it’s meant to relieve or remove.

In cases across the spectrum of illnesses and abuses, including the case of NSAID use or abuse for chronic pain, the evidence that CBT is more effective than other interventions is very strong.

How CBT works

Pain doesn’t happen only in the place that hurts. It also happens in the brain, where nerve signals from the pain site are received—and then mixed into a cocktail of associations and emotions from your brain’s library of experiences.

CBT is about recognizing the role your mind and emotions play in your experience of chronic pain—and overriding them, ignoring them, changing or denying them, or any of many coping mechanisms.

It’s about changing, for example, “Oh my god, the pain is back and nothing ever helps” to “I can handle this.”

And it works.

“Pain causes stress, and stress affects pain control chemicals in the brain, such as norepinephrine and serotonin,” says psychiatrist Joseph Hullett, MD. “CBT reduces the arousal that impacts these chemicals.”

In one of many studies that confirm the role of those emotions and associations, the following significant relationships were reported:

  • Ignoring and reinterpreting the pain reduced the time patients felt impeded by pain (downtime)
  • Diverting thoughts away from pain to something else reduced the intensity of pain
  • “Catastrophizing”—expecting a negative outcome—increased feelings of physical and psychosocial impairment
  • Increased use of praying and hoping decreased pain intensity
  • Decreased catastrophizing decreased feelings of physical and psychosocial impairment

Wait—Ignoring and reinterpreting. Diverting thoughts. Praying and hoping. Not expecting the worst.

These “mind games” are therapeutic?

Absolutely—because they’re anything but games.

CBT is most often used as a co-therapy with other pain management methods, e.g., medications, physical therapy, weight loss, massage. And it’s often one of the most successful interventions. Dr. Hullett says CBT is almost always at least as good as or better than other treatments—minus the risks and side effects of medications.

CBT Therapy

Most CBT for pain control consists of weekly group or individual sessions lasting 45 minutes to two hours.

Your therapist will spend intensive time with you, discussing the causes and history of your pain and how you now deal with it. Your homework, with most therapists, will be a detailed, self-observant diary of your pain experiences—when they come, when they go, and most importantly, your emotional response to them.

When you identify negative responses, for example, “Nothing ever helps”—your therapist will will help you replace the negatives with positives. Results can be immediate, as with the chronic back pain research I described.

And they can be blessedly long-lasting, if you stick with it.

As always, talk to your doctor before trying CBT.


Last Updated: June 23, 2021
Originally Published: September 16, 2015