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CBT and CFT for Chronic Pain
Current Pain and Headache Reports ( IF 3.7 ) Pub Date : 2021-04-01 , DOI: 10.1007/s11916-021-00948-1
Graham Hadley 1 , Matthew B Novitch 2
Affiliation  

Purpose of Review

Chronic pain is a widespread public and physical health crisis, as it is one of the most common reasons adults seek medical care and accounts for the largest medical reason for disability in the USA (Glombiewski et al., J Consult Clin Psychol. 86(6):533-545, 2018; Schemer et al., Eur J Pain. 23(3):526-538, 2019). Chronic pain is associated with decreased functional status, opioid dependence and substance abuse disorders, mental health crises, and overall lower perceived quality of life (Korff et al., J Pain. 17(10):1068-1080, 2016). For example, the leading cause of chronic pain and the leading cause of long-term disability is low back pain (LBP) (Bjorck-van Dijken et al. J Rehabil Med. 40:864–9, 2008). Evidence suggests that persistent low back pain (pLBP) is a multidimensional biopsychosocial problem with various contributing factors (Cherkin et al., JAMA. 315(12):1240-1249, 2016). Emotional distress, pain-related fear, and protective movement behaviors are all unhelpful lifestyle factors that previously were more likely to go unaddressed when assessing and treating patient discomfort (Pincus et al., Spine. 38:2118–23, 2013). Those that are not properly assisted with these psychosocial issues are often unlikely to benefit from treatment in the primary care setting and thus are referred to multidisciplinary pain rehabilitation physicians. This itself increases healthcare costs, and treatments can be invasive and have risks of their own. Therefore, less expensive and more accessible management strategies targeting these psychosocial issues should be started to facilitate improvement early. As a biopsychosocial disorder, chronic pain is influenced by a range of factors including lifestyle, mental health status, familial culture, and socioeconomic status. Physicians have moved toward multi-modal pain approaches in order to combat this public health dilemma, ranging from medications with several different mechanisms of action, lifestyle changes, procedural pain control, and psychological interventions (Fashler et al., Pain Res Manag. 2016:5960987, 2016). Part of the rehabilitation process now more and more commonly includes cognitive behavioral and cognitive functional therapy. Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control. While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior.

Recent Findings

CFT differs from CBT functionally, as instead of improving managing/coping mechanisms of pain control from a solely mental approach, CFT directly points out maladaptive behaviors and actively challenges the patient to change them in a cognitively integrated, progressive overloading functional manner (Bjorck-van Dijken et al. J Rehabil Med. 40:864–9, 2008). This allows CFT to be targeted to each individual patient, with the goal of personalized reconceptualization of the pain response. The end goal is to overcome the barriers that prevent functional status improvement, a healthy lifestyle, and reaching their personal goals.

Summary

Chronic pain is a major public health issue. Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control. While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior.



中文翻译:

CBT 和 CFT 治疗慢性疼痛

审查目的

慢性疼痛是一种普遍存在的公共和身体健康危机,因为它是成年人寻求医疗护理的最常见原因之一,也是美国残疾的最大医学原因(Glombiewski 等人,J Consult Clin Psychol. 86(6 ):533-545, 2018;Schemer 等人, Eur J Pain. 23(3):526-538, 2019)。慢性疼痛与功能状态下降、阿片类药物依赖和药物滥用障碍、心理健康危机以及总体感知生活质量降低有关(Korff 等人,J Pain. 17(10):1068-1080, 2016)。例如,慢性疼痛和长期残疾的主要原因是腰痛 (LBP) (Bjorck-van Dijken et al. J Rehabil Med. 40:864-9, 2008)。有证据表明,持续性腰痛 (pLBP) 是一个多维的生物心理社会问题,具有多种促成因素 (Cherkin 等人, JAMA. 315(12):1240-1249, 2016)。情绪困扰、与疼痛相关的恐惧和保护性运动行为都是以前在评估和治疗患者不适时更容易忽视的无益生活方式因素(Pincus et al., Spine. 38:2118-23, 2013)。那些在这些心理社会问题上没有得到适当帮助的人通常不太可能从初级保健机构的治疗中受益,因此被转诊给多学科疼痛康复医生。这本身会增加医疗保健成本,而且治疗可能是侵入性的,并且有其自身的风险。所以,应该开始针对这些心理社会问题的成本更低、更容易获得的管理策略,以促进及早改善。作为一种生物心理社会障碍,慢性疼痛受到一系列因素的影响,包括生活方式、心理健康状况、家庭文化和社会经济地位。为了应对这一公共卫生困境,医生已转向多模式疼痛治疗,包括具有多种不同作用机制的药物、生活方式的改变、程序性疼痛控制和心理干预(Fashler 等人,Pain Res Manag. 2016: 5960987,2016)。部分康复过程现在越来越普遍地包括认知行为和认知功能治疗。认知功能疗法 (CFT) 和认知行为疗法 (CBT) 都是多维心理方法,用于对抗难以控制的疼痛的心理部分。虽然这些疗法在方法上大相径庭,但它们提出了这样一种观点,即可以而且应该使用应对机制来靶向慢性疼痛,帮助患者了解疼痛的病理生理过程并改变行为。

最近的发现

CFT 在功能上不同于 CBT,因为 CFT 不是从单纯的心理方法改善疼痛控制的管理/应对机制,而是直接指出适应不良的行为,并积极挑战患者以认知整合、渐进超负荷功能的方式改变它们 (Bjorck-van Dijken et al. J Rehabil Med. 40:864-9, 2008)。这使得 CFT 可以针对每个患者,目的是对疼痛反应进行个性化的重新概念化。最终目标是克服阻碍功能状态改善、健康生活方式和实现个人目标的障碍。

概括

慢性疼痛是一个重大的公共卫生问题。认知功能疗法 (CFT) 和认知行为疗法 (CBT) 都是多维心理方法,用于对抗难以控制的疼痛的心理部分。虽然这些疗法在方法上大相径庭,但它们提出了这样一种观点,即可以而且应该使用应对机制来靶向慢性疼痛,帮助患者了解疼痛的病理生理过程并改变行为。

更新日期:2021-04-01
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