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Cognitive Behaviour Therapy or CBT means for the Biopsychosocial Behaviour Model understanding the adverse behavioural effects due to Chronic Pain has important implications for treatment and management.  Simply stated, the Biopsychosocial Behaviour Model predicts that if biological, personal and/or environmental factors appear to be contributing to an emerging Chronic Pain condition (or syndrome), as many as possible of these facets should be intervened through CBT to prevent say Chronic Pain from becoming unnecessarily disabling.  Failure to successfully introduce Cognitive Behaviour Therapy risks creating a major long term health problem with all its likely complications and emotional and financial costs (explicit health costs and foregone productivity).

Cognitive Behaviour Therapy for the Biopsychosocial Behaviour Model identify that treatment of some disease, illness or Chronic Pain requires that a health care 'team' address biological, psychological and social influences upon a patient's functioning. 

Specifically for Chronic Pain, CBT for pain management is based upon a cognitive-behavioural model of pain (Turk, Meichenbaum, & Genest, 1983) which posits that Chronic Pain is a complex experience that is not only influenced by its underlying pathophysiology, but also by an individuals' cognitions, affect, and behaviour (Keefe & Gil, 1986).

CBT for management of Chronic Pain has three basic components:

1.     A treatment rationale that helps patients understand that cognitions and behaviour can affect the pain experience and emphasizes the role that patients can play in controlling their own pain.

2.     Coping skills training is provided in a wide variety of cognitive and behavioural pain coping strategies. Progressive relaxation and cue-controlled brief relaxation exercises are used to decrease muscle tension, reduce emotional distress, and divert attention from pain.  Activity pacing and 'pleasant activity scheduling' are used to help patients increase the level and range of their activities. Training in distraction techniques such as pleasant imagery, counting methods, and use of a focal point helps patients learn to divert attention away from severe pain episodes.  Cognitive restructuring is used to help patients identify and challenge overly negative pain-related thoughts and to replace these thoughts with more adaptive, coping thoughts.

3.     Application and maintenance of learned coping skills.  During this phase of treatment, patients are encouraged to apply their coping skills to a progressively wider range of daily situations.  Patients are taught problem solving methods that enable them to analyse and develop plans for dealing with pain flares and other challenging situations. Self-monitoring and behavioural contracting methods also are used to prompt and reinforce frequent coping skills practice.

CBT for pain management is typically carried out in small group sessions of 4 to 8 patients that are held weekly for 8 to 10 weeks. The groups are typically led by a psychologist or psychologist-nurse educator team.

Depending on the nature of the Chronic Pain, commencing a REA within a LCCBSG can divert attention from pain and provide a 'pleasant activity scheduling' which may distract the patient from their Chronic Pain and enhance Self-esteem and physical appearance/fitness - explained in 2. above being the Second Basic Component Of CBT.  For example, sitting in a chair can often be the worst thing for lower back pain because the spine is not sufficiently supported by the core muscles due to a comfortable chair taking the load, whereas working the core muscles when cycling out of the saddle whilst not bowing the lower back can trigger lots of important muscles to do some work.  The sense of physical achievement from completing a bicycle ride once thought beyond the capability of the patient can provide enormous self-belief to enhance Coping Skills.  However, alas, some lower back injuries are aggravated by cycling, but some of these can be overcome by strengthening and lengthening the core muscles as well as the hamstrings and quadriceps.

The rationale of the Hypothesis is consistent with -

(A)       Second Basic Component Of CBT under the Biopsychosocial Behaviour Model to treat some diseases, some illnesses, and some types of Chronic Pain through:

2.     Providing coping skills training across a wide variety of cognitive and behavioural pain coping strategies. 
Progressive relaxation and cue-controlled brief relaxation exercises are used to decrease muscle tension, reduce emotional distress, and divert attention from pain. 
Activity pacing and 'pleasant activity scheduling' are used to help patients increase the level and range of their activities.
Training in 'distraction techniques' such as pleasant imagery, counting methods, and use of a focal point helps patients learn to divert attention away from severe pain episodes. Cognitive restructuring is used to help patients identify and challenge overly negative pain-related thoughts and to replace these thoughts with more adaptive, coping thoughts.

 

   The RTV Promotion "Hilly Rides Challenge in the 10 Months Tenure Of Primary Research Programme will film and chronicle that accepting a lofty, physical Challenging goal(s) in 'pleasant imagery' - the great outdoors - within a LCCBSG 'pleasant activity scheduling' as a mental diversion from the pressures of modern life, utilising 'counting methods' by clicking away the achievement kilometres, and 'use of a focal point to divert attention away', namely a positive sporting Challenge will replace thoughts that involve the Taskforce's Three Public Health Risks with more adaptive, coping thoughts. 

 

Refer "The high price of pain:  the economic impact of persistent pain in Australia - November 2007" by Access Economics Pty Limited for MBF Foundation, Biopsychosocial Behaviour Model, Chronic Pain and Second Basic Component Of CBT.