Rethinking "Chronic Pain": Patient Perspectives on Developing an Integrated Psychology and Physical Therapy Treatment

Chronic pain affects approximately 20% of U.S. adults and is associated with substantial psychological distress and functional impairment, underscoring the need for effective, patient-centered interventions. Evidence supports the use of cognitive-behavioral therapy (CBT) and physical therapy (PT) in chronic pain management; however, there remains limited guidance regarding how to integrate these principles within a single manualized intervention. This study describes the early-stage, formative phase of a multi-stage project to adapt an existing CBT manual for chronic pain by incorporating PT principles. Two focus groups with adults living with chronic pain were co-facilitated by a psychologist and a physical therapist, and data were analyzed using thematic analysis. Participants described frustration with communication and care coordination, dissatisfaction with the label "chronic pain," reliance on trial-and-error treatments, loss of identity and independence, an emotionally complex relationship with pain, and identified priorities relevant to intervention adaptation. Findings were used to inform patient-centered adaptations, including incorporating pain neuroscience education, reconsidering use of the term "chronic pain," and adding modules addressing identity, advocacy, and interprofessional collaboration. These findings provide formative, patient-informed insights to guide the early-stage refinement of integrated pain interventions and inform subsequent phases of manual development and testing.