woman holding head due to chronic pain
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Summary: Yes, therapy can help people with chronic pain. Previous studies show mental health therapy can help people with chronic pain, with cognitive behavioral therapy (CBT) and dialectical behavior therapy yielding the best results. A new study examines the impact of CBT delivered via telehealth on people with chronic pain.

Key Points:

  • Chronic pain is associated with decreased quality of life caused by functional physical limitations.
  • Chronic pain is associated with decreased overall wellbeing caused by psychological and emotional effects.
  • Various factors guide the need for research on chronic pain management, such as the risks of opioid medications and the cost of ongoing use of medical services
  • Understanding the role of mental health therapy for people with chronic pain is important in developing safe and effective models for long-term pain management.

What is Chronic Pain?

To understand chronic pain and therefore understand whether therapy can help people with chronic pain, we first need a basic clinical definition of pain. Experts on pain from the National Institutes of Health (NIH) and the International Association for the Study of Pain (IASP) define pain as follows:

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”

The same experts offer this definition of chronic pain:

“Pain that lasts for three months or longer.”

Studies show that close to 25% of adults in the U.S. experience chronic pain. In contrast to acute or typical pain, experts at the IASP indicate that chronic pain can:

  • Be present constantly
  • Come and go unpredictably
  • Interfere with daily life
  • Degrade physical and emotional wellbeing
  • Persist after initial cause is resolved

The consequences of chronic pain include, but are not limited to, impairments or negative effects on:

  • Sleep
  • Cognition
  • Brain function
  • Cardiovascular health
  • Sexual function
  • Mental health
  • Emotional health

Those are the big-picture consequences of pain and chronic pain. But what’s the connection between chronic pain and mental health?

Pain, Chronic Pain, and Mental Health

The study “Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis” presents important information from a peer-reviewed analysis of the impact of chronic pain on mental health. They analyzed the overlap between chronic pain and the two most common mental health disorders among adults in the U.S. and worldwide: depression and anxiety.

Here’s what they found.

Chronic Pain and Mental Health Among Adults

Among adults with chronic pain:

  • Symptoms of depression: 39%
  • Clinical diagnosis of depressive disorders:
    • Major depressive disorder (MDD): 37%
    • Persistent depressive disorder (PDD): 6.3%
  • Symptoms of anxiety: 40%
  • Prevalence of anxiety disorders:
    • Generalized anxiety disorder (GAD): 17%
    • Panic disorder (PD): 7.5%
    • Seasonal affective disorder (SAD): 2.2%

Those are the big-picture figures related to chronic pain and mental health.

However, there’s an aspect of chronic pain we haven’t addressed yet: the association of chronic pain with increased suicide risk. A study published in 2023 called “Prevalence of Suicidal Behavior in Patients With Chronic Pain: A Systematic Review and Meta-Analysis of Observational Studies” showed the following results.

Chronic Pain and Suicidality Among Adults

Among adults with chronic pain:

  • Presence of any suicidal ideation: 28.9%
  • Presence of any suicide attempts: 10.8%
  • Prevalence past two-week suicidal ideation: 25.9%
  • Prevalence of past-year suicide attempts: 1.3%

The researchers made this important observation, which is directly relevant to our discussion:

“Potential protective factors included pain coping and self-efficacy, older age, certain race/ethnicity groups, and marriage.”

Coping skills and self-efficacy are both core objectives in any type of menta health therapy. They’re also core objectives of the type of therapy we discuss in this article – cognitive behavioral therapy (CBT) – that may help people with chronic pain.

Therapy for People With Chronic Pain: The New Research

The study we mention briefly in our introductory summary – “Telehealth and Online Cognitive Behavioral Therapy–Based Treatments for High-Impact Chronic Pain” – poses the following question:

How effective are remote, scalable cognitive behavioral therapy skills training programs for chronic pain (CBT-CP) for individuals with high-impact chronic pain?

To ensure we’re on the same page, this study focuses on CBT via telehealth for people with chronic pain, as opposed to CBT delivered in an inpatient setting or CBT delivered in an in-person outpatient setting. The research team focused on learning how patients with a lower level of access to/use of in-person care – whether because of resources, access, or personal preference – can benefit from remote therapy for chronic pain.

To conduct the study, researchers recruited 2,331 patients with high impact, chronic musculoskeletal pain and divided them into three groups:

  • 1st Group: 778 patients participated in 8 remote CBT skills group session facilitated by a professional health coach
  • 2nd Group: 776 patients participated in a remote, self-directed 8-session CBT skills program
  • 3rd Group: 777 patients received standard non-CBT care, with help from a pain management resource guide

To determine the effectiveness of each group compared to the others, each participant completed the 11-item Brief Pain Inventory – Short Form (BFI-S) at the start of the study and at three, six, and 12 months after program initiation.

The research team identified the following primary outcome related to the three interventions above and patient experience of pain:

Minimal clinically important difference (MCID) in pain severity score on the BFI-S, defined as a scored reduction of 30 percent or more at 3 months.

In addition, the research team identified the following secondary outcomes:

  • MCID in pain severity score on the BFI-S at 6 months
  • MCID in pain severity score on the BFI-S at 12 months
  • Reductions in the following categories at 3,6, and 12 months, measure by Patient-Reported Outcomes Measurement Information System (PROMIS) tests:
    • Pain intensity
    • Pain-related interference with life, overall
    • Impact of pain on social function
    • Impact of pain on physical function
    • Overall patient impression of change

Let’s take a look at what they found.

Results: How Therapy Can Help People With Chronic Pain

First, we’ll share data on the primary outcome the research team examined, which was any change in pain severity three months after the beginning of the study. Remember: group 1 received online CBT with a health coach, group 2 completed a self-directed online CBT program, and group 3 did not receive CBT, but standard care with the help of a written pain management resource guide.

Primary Outcome: Pain Severity at 3 months

30% + Reduction (MCID) PFIS:
  • 1st Group: 32%
  • 2nd Group: 26.6%
  • 3rd Group: 20.8%
Comparison Between Groups:
  • 1st Group compared to 3rd Group: 54% increased chance of MCID
  • 2nd Group compared to 3rd Group: 28% increased chance of MCID
  • 1st Group compared to 2nd Group: 20% increased chance of MCID

This data shows that group 1 experienced the most significant reductions in pain severity, meeting the criteria for MCID – minimal clinically important difference – at three months after the start of the study. The other two groups reported significant reductions that did not, however, meet the study criteria for MCID.

Next, let’s look at the next set of outcomes: the effect of the two CBT interventions on pain severity at 6 months, and a variety of functional variables at 3, 6, and 12 months after the start of the study, as compared to the non-CBT group.

Secondary Outcome: Pain Severity at 6 months and Other Outcomes

MCID on BFI-S and Pain-related PROMIS metrics:

6 months:

  • Pain intensity: MCID identified
  • Pain-related interference with life, overall: MCID identified
  • Impact of pain on social function: MCID identified
  • Impact of pain on physical function: MCID identified

12 months:

  • Pain intensity: MCID identified
  • Pain-related interference with life, overall: MCID identified
  • Impact of pain on social function: MCID identified
  • Impact of pain on physical function: MCID identified

Compared to treatment as usual – i.e. no form of CBT – the two CBT groups showed substantial benefit from virtual CBT, with or without a professional health coach.

Here’s how the researchers summarize their findings:

“Remote, scalable CBT-CP treatments (delivered either via telehealth or self-completed modules online) resulted in modest improvements in pain and related functional/quality-of-life outcomes compared with usual care among individuals with high-impact chronic pain. These lower-resource CBT-CP treatments could improve availability of evidence-based nonpharmacologic pain treatments within health care systems.”

From our point of view, these outcomes are important. Not only do they show that virtual CBT therapy can help people with chronic pain, but it can help without expert therapists. We’ll discuss these results further below.

How This Study Helps Our Patients

The primary results of this study are significant:

CBT delivered virtually, with or without a professional facilitator, can reduce pain severity in patients with chronic pain.

The results of this study imply something more significant, however, which we can use for our patients:

Combining virtual CBT with a professional therapist may improve outcomes related to chronic pain more substantially than virtual CBT.

In addition, in-person CBT for chronic pain – meaning live, in-person sessions either during inpatient treatment or outpatient treatment – may have the potential to offer the greatest level of relief for patients in chronic pain, while simultaneously reducing and addressing symptoms of comorbid mental health disorders.

This is meaningful for our providers and patients because of the high rates of mental health disorders among people with physical conditions associated with chronic pain. Consider the following facts, published in the review analysis we mention above, which focused on depression and anxiety among people with chronic pain.

Pain Conditions and Mental Health

Fibromyalgia

  • Depression: 54% of patients with fibromyalgia
  • Anxiety: 56% of patients with fibromyalgia had anxiety

Arthritis

  • Depression: 29% of patients with arthritis
  • Anxiety: 18% of patients with arthritis

Young Patients

  • Depression: younger patients with chronic pain reported more depressive symptoms than older patients
  • Anxiety: younger patients with chronic pain reported more symptoms of anxiety than older patients

Gender:

  • Depression: women with chronic pain were more likely to receive a diagnosis for major depressive disorder (MDD), compared to men.
  • Anxiety: women with chronic pain were more likely to receive a diagnosis for generalized anxiety disorder (GAD), compared to men.

Our extensive experience teaches us that two types of therapy can help people with chronic pain an comorbid mental health disorders:

These approaches help patients learn how thoughts and emotions impact pain, and vice versa. In addition, they help patients learn how thoughts emotions associated with mental health disorders affect the experience of pain. Therapy can help people with chronic pain acquire practical skills to understand and address the consequences of the complex interplay between pain, thought, emotion, and behavior, in order to find balance, improve overall wellbeing, and restore practical function across a broad range critical life domains.

Finding Support: Resources

If you or someone you know needs professional treatment and support for a chronic pain, a complex health disorder, or both, please contact us here at Crownview Psychiatric Institute. We can help. In addition, you can find support through the following online resources:

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.