The Method to Manage Chronic Pain Used by America's Top Hospitals (Hint: It's Not Apple Pie)

If I told you there’s an effective treatment for chronic pain that doesn’t involve drugs or surgery, a treatment that’s as easy as eating apple pie (with a scoop of cinnamon ice cream on the side), would you tell me I’m crazy?

OK, you’d be right: that would be crazy. If anyone proposes anything is as easy as apple pie, and they’re not talking about actually eating apple pie, your scam-detector should probably go off. BUT… there is a non-drug, non-surgical method for managing chronic pain with lots of supporting studies to back it up. Though not as easy as eating apple pie (what is?), this program is very doable.

The program I’m referring to is Cognitive Behavioral Therapy for Chronic Pain, also known as CBT-CP. It’s a method used by the Veterans Health Administration, Kaiser Permanente, Cleveland Clinic, and many other highly-respected hospitals to help manage chronic pain.  CBT-CP includes several related pieces, including strategies to improve sleep, skills to better cope with pain and flare-ups, techniques to relax and reduce stress, and training to manage self-destructive patterns of thought. Besides being used by many of the premier hospitals in the country, CBT-CP has several dozen studies to back it up. One 2006 study found that patients using CBT-CP were three times more likely than other patients to report pain did not interfere with their lives, and twice as likely to report that their pain had improved.

To understand how CBT-CP works, it helps to understand that chronic pain is a lot more complex than we often imagine. In a nutshell, chronic pain is caused and affected by a lot more than just damage to the body; as a result, managing chronic pain is complex too. Part of the problem is that pain can cause things that themselves worsen the pain. It’s what known as the Cycle of Pain (sounds like a really unpleasant and rickety State Fair roller coaster, huh?). Pain can cause us to decrease our activity, which can increase pain.  Pain can trigger negative emotions that cause us to avoid social situations and to feel isolated, which in turn can increase our pain. Finally, pain can also cause us to feel disabled and stressed out, which – you guessed it – can increase our pain.

The Cycle of Pain can reinforce chronic pain.


CBT-CP helps patients break out of this Cycle of Pain by teaching important self-management skills. For example, when pain starts to flare up, relaxation techniques can stop muscle tensing that actually increases the pain we feel; likewise, improving sleep quality or encouraging exercise can improve chronic pain.

To access CBT-CP, you can go to a psychotherapist, psychologist, or psychiatrist that is trained to provide it, usually in weekly sessions over a few months. At SamaCare, we offer an online self-management program that includes the skills training of CBT-CP, paired with personalized 1-on-1 support from health coaches. Participating in a CBT-CP program doesn’t mean you have to change your medications or other aspects of your medical treatment. It’s one more tool in your chronic pain toolbox — in another post, we’ll take a look at a few other evidence-based tools that might fit in that toolbox.

CBT-CP is not a miracle cure. It requires a patient to actively take part in learning and practicing pain management skills. It’s definitely not as easy as eating apple pie; but if you live with chronic pain, then you know nothing ever is.

Would you try CBT-CP? Please share your thoughts in the comments below.

Want to learn evidence-based strategies to manage your pain, with the support of a coach?



Cleveland Clinic. Chronic Pain Rehabilitation Program. (n.d.). Retrieved June 12, 2017, from>

Hoffman, B.M., Papas, R.K., Chatkoff, D.K., & Kerns, R.D. (2007). Meta-analysis of psychological interventions for chronic low-back pain. Health Psychology, 26(1), 1-9. doi: 10.1037/0278-6133.26.1.1

Kaiser Permanente. Cognitive-Behavioral Therapy for Pain Management. (n.d.). Retrieved June 12, 2017, from

Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80(1-2), 1-13.

Murphy, J.L., McKellar, J.D., Raffa, S.D., Clark, M.E., Kerns, R.D., & Karlin, B.E. Cognitive behavioral therapy for chronic pain among veterans: Therapist manual. Washington, DC: U.S. Department of Veterans Affairs.