Abstract
The origin, course and subsequent maintenance of pain is influenced by psychosocial factors. For this reason, psychotherapy is also used in pain management and the use of cognitive behavioral therapy (CBT) is dominant.
This chapter describes the history of CBT and its three basic approaches: behavioral, cognitive and cognitive-behavioral. The indication to CBT and the most frequent problems in treatment are defined.
Basic CBT techniques in chronic pain management, namely cognitive restructuring and the practice of skills for pain and stress management (education, adaptive positive self-instruction, relaxation and imagination, graded activity, exposition, structured problem solving and relapse coping) are specified. Particular fields of chronic pain which represent the goal of the multidisciplinary program of pain management including CBT are examined.
The authors structure the basic assumptions of a successful program: direct and indirect positive reinforcement of pain behavior, positive reinforcement of required behavior, improvement of physical condition, cognitive reframing, education, training in CBT in pain management and conforming to CBT principles. The chapter summarizes the efficiency of CBT in chronic non-malignant pain management in adult patients, describes problems in its monitoring and suggests some innovations increasing its use.