Commentary - Journal of Physical Therapy and Sports Medicine (2021) Volume 5, Issue 6
Physical treatment with a cognitive-behavioral component
Department of Sports Medicine
E-mail: [email protected]
Accepted on November 10, 2021
Chronic pain is a common and often debilitating illness among the elderly. Prior studies have found clear links between chronic pain and significant morbidity, such as depression and functional impairment, as well as increased health-care consumption. Chronic pain is a serious public health issue because of its prevalence, impact on health, and expenses, which are estimated to be in the billions of dollars each year. Analgesic medicine is the most often used treatment for persistent pain (e.g., acetaminophen, nonsteroidal anti-inflammatory drugs, opioids). Analgesic drugs are also the most commonly recommended treatment for older people. Although many older people benefit from analgesic medications, the expense and side effects associated with many of these treatments, as well as the possibility of drug-drug combinations, represent substantial challenges.
Furthermore, despite regular use of analgesic drugs, many older persons continue to experience significant pain. As a result of these constraints, a call for effective nonpharmacological therapies to address chronic pain has been made. Other nonpharmacological treatments to pain management include cognitive-behavioral therapy (CBT), hypnosis, and individual psychotherapy, in addition to physical therapy. The use of CBT in this study is of special importance because it has been shown to be effective for a wide spectrum of chronic pain problems. Cognitive-behavioral therapy (CBT) is a type of therapy that uses a variety of psychological strategies to help patients gain more control over their suffering. The idea that a person's ideas, attitudes, and behaviours play a key part in determining his or her total pain experience underpins this therapy.
Standard CBT pain protocols aim to:
(1) Teach patients specific cognitive and behavioural skills to better manage pain;
(2) Educate patients about the effects that specific cognitions (thoughts, beliefs, attitudes), emotions (fear of pain), and behaviours (activity avoidance due to fear of pain) can have on pain; and
(3) Emphasise the primary role that patients can play in controlling their own pain as well as pain adaptations.
Cognitive-behavioral therapy has been shown to be effective in lowering pain and impairment in middle-aged adults suffering from a variety of chronic pain problems. Previous studies have also shown that a CBT programme aimed at pain management can benefit older persons. Despite the fact that several effectiveness studies have established the advantages of CBT, few older persons use it to manage their symptoms.
Only 4% of older primary care patients with chronic pain reported utilising cognitive approaches for pain management, according to a recent study, while only 3% of older persons with chronic pain reported using cognitive methods for pain management in a nonclinical study. Multidisciplinary pain management programmes frequently provide access to psychological treatments such as CBT. Older patients, on the other hand, are less likely to be referred to this type of programme, limiting their access to these interventions. These findings, combined with the findings of a recent study demonstrating that older persons with chronic pain are extremely responsive to using cognitive procedures as a form of pain management, lend more credence to efforts to teach CBT techniques to people with chronic pain in traditional settings.
CBT is increasingly being examined and regarded as part of a multimodal approach for persons suffering from chronic pain. Activity pacing, sleep hygiene, pain perception, disability, mood, and catastrophization have all been researched using CBT. Recent clinical studies and integrative reviews indicated that 6-10 weeks of CBT reduced pain severity, but more research is needed to determine the best dosage.
We believe CBT is comparable to physical therapy in that both promote the adoption of self-management strategies and employ similar approaches including graded activity pacing and relaxation training. Cognitive restructuring to detect unhelpful thought patterns and the use of imagery to increase goal achievement are two more CBT approaches utilised by physical therapists. Instructing chronic pain patients in the use of specific coping skills like these can help to reduce activity avoidance and improve exercise programme adherence and functional recovery.
To determine the extent to which physical therapists currently use CBT techniques and other physical therapy interventions, as well as their interest in using CBT treatments and barriers to using CBT treatments, descriptive statistics (frequency for categorical data, mean and standard deviation for continuous data) were computed. Given the under-referral of older adults to multidisciplinary programs,the importance of integrating psychological treatments for pain management into standard care, and the philosophical similarities between physical therapy and CBT, it seems important to look into the possibility of incorporating CBT into physical therapy for the treatment of older adults with chronic pain.