Chronic Pain and Opioid Use: The Important Role of CBT Therapists – Miller, A.R., 2018 c/- The Beck Institute


  • The epidemic co-occurrence of chronic pain and opioid use has resulted in an expensive ($635 billion per year) and deadly (72,000 overdose deaths per year) problem in the United States.
  • Chronic pain and opioid use sufferers make frequent visits to primary care practices, emergency rooms, and medical specialists.
  • Often physical injuries or illnesses cause painful sensations. It comes as little surprise then, that the first question many pain sufferers ask upon meeting a CBT therapist is, “How can a therapist help me with my physical pain?” Although the true answer is, “A CBT therapist can help quite a lot,” that is the last thing we would say to them.
  • Why? People who have chronic pain have endured much suffering. They’ve usually tried a number of strategies to get relief–without success. CBT is usually last on their list of things to try. Many have lost hope. To add to their pain, they frequently report that “No one listens” and “No one understands”. So, we need to take care not to cut them off or make guarantees. Empathy, reflective listening, and other counselling skills are essential to develop a solid therapeutic relationship.

A strong alliance helps patients to be more amenable to trying CBT techniques.

  • It is important to know that adverse experiences (sometimes from childhood) and other psychosocial factors may set the stage for an individual to develop chronic pain, though most of the time treatment focuses on the here-and-now.
  • When individuals experience acute pain, the way that they think about the pain (e.g. “unbearable”) and how they anticipate its effect on their life (e.g. “catastrophic”) may be predictive of whether the individual will develop chronic pain.
  • Life stress (especially social, work, family or physical stress), and concomitant physical tension in the body – these combine to intensify pain .
  • Having pain is a problem in and of itself, and people with chronic pain often have additional problems:
    • trouble meeting their role responsibilities at work,
    • keeping up with household needs, and
    • taking care of children, to name a few.
    • Many feel helpless to deal with the pain or to overcome its impact on their lives. When it gets to this point, these patients may become disheartened and believe they are worthless or a burden to those around them. Depression, anxiety and suicidal thoughts often ensue.

Virtually no one likes pain. When we have pain, we want to get rid of it.

Go to the source for the full article – see below



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