The cognitive behavioral perspective on pain management in terminal illness

Cognitive Behavioral Therapy (CBT) can be an effective non-medical treatment for the alleviation of pain-related suffering in patients with advanced disease. CBT offers a common-sense theoretical model and a variety of rational and pragmatic techniques that are easy for both patients and health professionals to understand and practice. The perspective emphasizes two ideas: that pain and suffering are not the same, and that patients can exercise substantial personal control over their thoughts, feelings, and behavior. Suffering is a feeling of pervasive personal destruction, whereas pain is a sensory stimulus that does not necessarily imply general personal disintegration. CBT teaches patients to practice relaxation and active coping skills to increase pain tolerances, and to modify thoughts and attitudes that increase the perception of personal disintegration. Even in the most advanced stages of a terminal illness patients can practice these skills and experience themselves as active agents that can reduce their suffering and enhance their sense of well-being.