From the Guidelines
For a patient with chronic pain and comorbid depression seeking non-medication treatment, cognitive behavioral therapy (CBT) should be considered as a first-line option. CBT helps patients develop coping strategies to manage pain and address negative thought patterns contributing to depression 1. A typical regimen involves weekly 45-60 minute sessions for 8-12 weeks with a trained therapist, followed by maintenance sessions as needed. Other effective options include mindfulness-based stress reduction (MBSR) and physical therapy combined with graded exercise.
Key Considerations
- CBT promotes patient acceptance of responsibility for change and the development of adaptive behaviors, such as exercise, while addressing maladaptive behaviors, such as avoiding exercise due to fears of pain 1.
- Environmental enrichment, which includes social, sensory, physical, and cognitive stimulating elements, has been proposed as a non-pharmacological tool to ameliorate chronic pain, depression, and anxiety 1.
- The ability of environmental enrichment to modulate neuroinflammation has been proposed as a mechanism to induce behavioral changes and relieve the physical and emotional burdens of chronic pain 1.
Implementation
- Patients should seek referrals to therapists specializing in pain management and mental health, while beginning simple mindfulness practices and gentle movement daily.
- Physical therapy should start with gentle exercises, gradually increasing intensity based on tolerance, ideally 2-3 sessions per week initially.
- Integrating social support through group therapy or pain management programs can enhance outcomes.
From the Research
Non-Medication Treatment Options for Chronic Pain and Comorbid Depression
- Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR) are two non-medication treatment options that have shown promise in managing chronic pain and comorbid depression 2, 3, 4, 5, 6
- CBT has been found to reduce pain intensity in 43% of trials and has been shown to be effective in reducing depressive symptoms 3, 4
- MBSR has been found to offer clinically important advantages relative to control for physical functioning, pain intensity, and depression symptoms 2
- Both CBT and MBSR have been found to be effective in decreasing catastrophizing and increasing self-efficacy and acceptance in patients with chronic pain 6
- The efficacy of online and in-person formats of CBT have been found to be comparable 4
- Mindfulness interventions, including MBSR, have been found to be superior to usual care in all diagnoses, but it is not possible to conclude their superiority over CBT 5