Just providing patients with relevant facts about chronic pain reduces its impact, according to previous studies. In a more active approach, cognitive behavioral therapy (CBT) aims to change how sufferers think about their pain and teach them strategies to deal with it.
For example, they learn to see stress as a challenge rather than a threat and to replace negative thoughts (“This pain is the worst in the world. I can’t bear it.”) with more optimistic ones (“The pain is bad, but I have ways to cope with it.”). They also practice relaxation, distraction, and other techniques that will, in fact, help them cope.
Considerable evidence has shown that such CBT can reduce pain, improve a patient’s ability to function, and cut medication use. But it requires learning and applying unfamiliar concepts.
About a decade ago, Thorn began working to make CBT more user-friendly for economically disadvantaged people. She had published a well-received handbook for therapists and workbook for patients, but she says, “I started getting emails from practitioners around the world who said, ‘Great, but how do you do this for people who aren’t comfortable reading and writing?’
“So I thought: Let’s see if I can adapt this. I went to the patients to find out.”
At that time, Thorn was conducting CBT groups for headache sufferers, some of them with low literacy levels. She asked for their thoughts on how to improve the treatment and patient materials. “They started by saying that we needed more pictures—and to cut the fancy words," she recalls.
With the draft of a new version in hand, she conducted focus groups with some 40 patients in rural Alabama, inviting more detailed comments. The resulting patient handbook has fewer words and simpler language than the original. The lettering is larger and cleaner, and the illustrations more meaningful.
The adapted therapy eliminates the written “homework” traditional in CBT; instead, there’s a “think, feel, act” exercise between sessions. During 10 weekly sessions, therapists use flip-charts to record patients’ observations and experiences, and they provide CDs that include session summaries and tips. In developing the new approach, Thorn learned and integrated what was most important to pain patients: to be listened to, have their pain taken seriously, and have nondrug treatments that worked.