Effects of cognitive-behavioral therapy on pain intensity and level of physical activity in Japanese patients with chronic pain- a preliminary quasi-experimental study -

Abstract

Introduction: Cognitive-behavioral therapy (CBT) is one of the psychological approaches and focuses on modifying distorted cognitions that affect persistent pain and pain behaviors. CBT involving an activity program could be applied to the treatment of chronic pain with physical and psychological dysfunctions. The aim of the present preliminary experimental study was to investigate the effectiveness of CBT by comparing treatment responders and non-responders by pain levels and physical activity levels in the patients with chronic pain in our multidisciplinary pain center. Methods: CBT was given for 6 months period in 12 patients. They were classified into effective group if they had verbal rating scale (VRS) score reduced by 2 points and into non-effective group if there were no changes in VRS, at 1 month after the beginning of the CBT. Pain intensity and physical activity were assessed by VRS and a three-dimensional accelerometer which were expressed as a total together with each activity intensity level- metabolic equivalents: METs 1-3, mild; METs 4-6, moderate; METs 7-9, heavy activity, and sampled at 1, 3 and 6 month intervals after the CBT. Results: The effective group had lower VRS at 3 and 6 months. They also had higher total physical activity score overall, and mild/moderate activity score was higher at 6 months. The heavy activity score was not different between-groups. VRS was lesser in the effective group at all three levels (1, 3 and 6 months) when compared with before the beginning of the CBT, whereas physical activity levels were similar at all three levels on each group. Conclusion: The study found that mild to moderate physical activity was associated with reductions in VRS in the effective group suggesting beneficial effects of low-load and high amount of physical activity in chronic pain patients attending a CBT intervention program.