“Working with Pain-Related Thoughts” is part of a series of six Integrative Health tools designed to assist clinicians who want to enhance patient’s chronic pain self-management skills.  For additional information, refer to the other materials in the “Self-Management of Chronic Pain” module.

The field of Cognitive Behavior Therapy (CBT) emphasizes that negative thought patterns can have a profound effect on our physical and mental well-being.  How we perceive a situation or even our day-to-day life can lead to higher stress levels and ultimately contribute to anxiety and depression.  Research suggests that many of the thoughts that we think are repetitive and can be negative.  This is often referred to as the negativity bias of our brain. Our brains are primed to pay attention to, focus on, and remember the negative things that occur.  Negative experiences are like Velcro, they tend to stick to us causing us to worry or ruminate about them long after they happen. 

When we’re not paying attention to our thought patterns, it’s easy for our minds to fall into a playback loop—thinking repetitive thoughts each and every day.  Depression, for example, is linked to negative beliefs related to hopelessness and helplessness.  Anxiety disorders are linked to thoughts of future possibility of danger and threat.  When we start to pay attention through some simple practices, we can notice the quiet ways we get stuck in negative patterns and then we can begin to reshape our thinking in more constructive ways.  Many psychological disorders can be treated and prevented, and stress can be reduced by carefully examining and restructuring our thinking to be more accurate.

The role of cognition is an important area of self-management in chronic pain.¹  CBT is at present the most widely used psychotherapeutic treatment for adults with chronic pain and secondary depression and anxiety.  It uses structured techniques involving multiple methods to modify cognition and behavior.

Pain catastrophizing, for example, is a common thinking pattern that occurs with chronic pain, and has been found to be one of the most important psychological factors contributing to perceived pain intensity and emotional distress.^2,3  People who catastrophize about their pain tend to have exaggerated worry, overestimate the likelihood of unpleasant outcomes, and think more helpless and distress-amplifying thoughts in response to pain.⁴