CBT for Pain Management and Living with a New Device

Cognitive behavioral therapy (CBT) is often the treatment of choice for behavioral issues, from depression to anxiety to insomnia. At Cleveland Clinic, CBT also is often an integral component of a care plan for patients suffering with chronic pain.

CBT is defined as short-term, goal oriented psychotherapy that seeks to alter patterns of thinking and behavior to change the way patients perceive and manage their pain.

The American Psychological Association cites multiple clinical studies showing CBT to be among the most effective treatments for improving management of chronic pain across the spectrum of pain conditions. CBT recognizes that each person is unique, and that their pain and its consequences are unique to them.

Patients of the Cleveland Clinic Department of Pain Management are often referred to pain psychologist Jill Mushkat Conomy, PhD, who screens patients before a decision is made to move forward with invasive medical interventions. She often uses CBT to help patients develop skills for managing the impact of pain on their life and to help them to live with an implant, including a neuromodulation device (e.g., spinal cord stimulator) or intrathecal pump/medication delivery system.

“I see patients to ensure that indications for the interventional pain procedure, including indwelling devices, are understood by the patient, and that there are no psychological factors that would preclude success for the patient,” she explains. The evaluation fulfills insurance requirements for these elective procedures. Once the evaluation is completed, it may lead to a series of appointments for CBT both pre- and post-procedure.

Doctors also refer patients to Dr. Mushkat Conomy for a prescreening if a patient is on, or being considered for, long-term opioid management for a chronic pain condition. “What I can do as a psychologist is point out areas of concern and coordinate treatment with the physicians,” she says. “Management of these patients is very much a team approach. It is also important to consider the impact that medications, opioid or otherwise, may have on an individual’s memory, behavior and cognitive function.

Making an assessment

Dr. Mushkat Conomy uses standardized psychological testing in conjunction with a clinical interview to assess the impact of the pain diagnosis on the life of the individual. Using a BioPsychoSocial model, which reflects the interaction of pain on biochemical, psychological, cognitive, and socioeconomic aspects of a person’s life, she is able to assess the overall impact of pain. This includes its impact on the patient’s family and friends, caregivers, coworkers and employers.

As she reviews these factors, she will work with the patient to develop skills for managing the challenges of living with pain. “CBT helps people to reframe the way they think about their pain and to learn how to manage their pain on a day to day basis,” she says. “Instead of the ‘catastrophe’ that chronic pain may be, individuals begin to see that it is a challenge in life that they can learn to cope with in a way that allows them to be in control of their life.”

She notes that stress, depression, weight gain, inactivity, and physical injuries can all contribute to disability associated with chronic pain. When a psychological issue is identified, Dr. Mushkat Conomy may schedule several CBT sessions with the patient to help them acquire the skills to deal with the difficulties they experience.