The Role of Mental Health in the Treatment of Chronic Pain

Scott G. Ravyts, PhD - Johns Hopkins University; Mariel Emrich, BS - University of Connecticut; Katherine E. Gnall, MS - University of Connecticut; Laura E. Laumann, MS - University of Connecticut

Chronic pain is very common. Approximately 1 in 5 adults (20.9%) in the US experience chronic pain each year. Chronic pain often negatively impacts quality of life and is also associated with a range of adverse mental and physical health conditions.

How Mental Health Affects Chronic Pain

Historically, chronic pain was viewed solely through a biomedical lens. That is, chronic pain was seen as a physical problem which required medical intervention (e.g., surgery, medication). Advances in pain-related research over the past several decades show that the biomedical model of pain is quite limited, and that medical treatments for chronic pain produce only limited benefits.

Thanks to extensive research, we now understand that pain is not just a physical experience. It is multifaceted and influenced by emotional and cognitive factors. In fact, the International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” We now consider chronic pain from a biopsychosocial perspective.

Importantly, by broadening our understanding of factors that influence pain, the biopsychosocial model of pain has helped researchers and healthcare providers identify important treatment targets for chronic pain. For example, pain catastrophizing, defined as the tendency to magnify, ruminate, or feel more helpless about pain is associated with worse pain outcomes including greater pain intensity and interference. Similarly, avoidance of movements or activities due to fear of pain or re-injury has been shown to be associated with long-term pain-related disability.

Mental health providers can play a key role in helping individuals cope with chronic pain by reducing pain-related negative thoughts and increasing an individual’s overall level of physical exercise and engagement in value-based activities.

Cognitive Behavioral Therapy (CBT) for Chronic Pain

Several available behavioral health treatments have been shown to improve outcomes among patients with chronic pain. These treatments directly target the psychological factors known to contribute to the experience of pain and suffering.

For instance, Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) aims to help individuals develop skills to better cope with their pain and reduce the impact of pain on everyday functioning. CBT-CP can be conducted in individual or group format and typically entails 8-12 weekly sessions.

Other emerging behavioral treatments also show great promise for improving the lives of individuals with chronic pain, including but not limited to Acceptance and Commitment Therapy (ACT), Emotional Awareness and Expression Therapy (EAET), and Pain Reprocessing Therapy (PRT). Each of these treatments aim to change how individuals view and respond to their pain; for instance, ACT aims to improve quality of life among individuals with chronic pain through increasing engagement with values-consistent activities that often get left behind when suffering with pain.

Including Mental Health Care in Chronic Pain Treatment

Adopting a biopsychosocial lens was a critical step in advancing our understanding of the etiology, course, and treatment of chronic pain. Behavioral treatments for chronic pain are not only effective, but also provide a safe alternative to pharmacological treatments. Ask your healthcare provider if a behavioral treatment for chronic pain is right for you.