Cognitive behavioral therapy in primary care

Abstract

Background: Chronic pain is prevalent, costly and commonly treated in primary care. Current evidence supports the use of integrated therapies that address the physiological and psychosocial factors in the pain experience. Cognitive behavioral therapy (CBT) has proven efficacy in the treatment of chronic pain conditions. However, psychological therapies, like CBT, are underutilized in chronic pain management. This may be the result of lack of mental health providers and typical delivery methods of individual therapy in private practice behavioral health settings. Objective: To review the evidence for the use of CBT techniques by health care professionals other than specialist in psychiatrics or psychology, for the management of chronic pain in primary care and community settings. Methods: The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PsycInfo, PubMed, Web of Science and Google Scholar databases were searched to identify qualitative and quantitative research involving CBT techniques used by non-mental health professionals in outpatient settings for adults with chronic non-cancer pain. Results: The search yielded 253 relevant records, and 11 met final selection criteria. CBT-based interventions delivered by non-mental health professionals were effective in reducing physical disability and pain severity in individuals with chronic non-cancer pain. Conclusions: Access to CBT-based interventions should be expanded to include delivery through health care professionals other than specialists in psychiatrics or psychology for the management of chronic pain in primary care.