Chronic Pain is a difficult issue to deal with and treat.  Sometimes people experiencing it do not know they have it.  Individuals tend to be consumed by their pain and feel helpless.  It is hard to think that you can get back to your life prior to pain when healthcare professionals are having trouble finding the root cause and when any activity causes you pain.  Chronic low back pain is shown to be as prevalent at 23% of the population.

It is important to not only treat the physical aspect but also the cognitive aspect for individuals with chronic pain.  Leventhal provided a self-regulation model that showed maladaptive illness perceptions can lead to maladaptive behavior; such as activity limitations.

I came across an article that developed and studied the effectiveness of a cognitive treatment of illness perceptions (CTIP).  The goal of this treatment method is to challenge and change perceptions of patients dealing with chronic pain by going through a 4 phase process.

Cognitive Treatment of Illness Perceptions (CTIP)

Phase 1: Mapping of Existing Illness Perceptions

  • Approximately 2 sessions to complete
  • The use of subjective information that focused on activity limitations as a starting point.
  • Then elaborating on thoughts about low back pain in relation to their limitation activity.
  • Example: I need to rest in bed in order to allow the pain to fade away.

Phase 2: Challenge Maladaptive Illness Perceptions

  • Approximately 2 sessions to complete
  • Create doubt about the most maladaptive illness perceptions
  • Example: Questioning the patient’s perception that resting in bed would decrease the pain.

Phase 3: Alternative Illness Perceptions are Formulated

  • Approximately 1 session to complete
  • Convert maladaptive perceptions to alternative perceptions that will help to increase physical activity
  • The physical therapist and patient both agree and conclude on plausible perceptions
  • Example: Doing light jobs is a suitable replacement for bedrest, as it allows the body to recuperate and it distracts away from the pain.

Phase 4: Alternative Perceptions are Tested and Strengthened by Confirming Their Utility in Daily Practice

  • On going once alternative perception is created
  • Example: The continuation of completing light jobs instead of bed rest.

This treatment protocol for perception modification gives recommendations for treatment time frame per phase.  It is recommended to use professional clinical judgement when using this for patients with chronic pain.

(Click the link below for access to the article)

Cognitive Treatment of Illness Perceptions in Patients with Chronic Low Back Pain: A Randomized Controlled Trial

Purpose: To compare the effectiveness of treatment of illness perceptions against a waiting list for patients with chronic low back pain.

Methods: They classified chronic pain as greater than 3 months of lower back pain.  They studied 156 subjects with an 18% withdrawl rate from treatment.  The subjects were randomized into a chronic low back pain group (experimental) and a waitlist group (control).  The researchers had an intention to treat.  The subjects were treated one time a week for 1 hour each session over a period of 10-14 weeks.  They completed the Cognitive Treatment of Illness Perception protocol for the first 5 weeks and then followed the subjects for the remainder of the treatment sessions.  The subjects were also expected to keep a diary on medical costs for their back such as doctor visits, physical therapy, and alternative methods.  They researchers measured change using the Patient-Specific Complaints Questionnaire (PSC), the Illness Perception Questionnaire (IPQ-R), and the Quebec Back Pain Disability Scale (QBPDS).

Results: They found significant improvement in reported reductions in back pain symptoms in the PSC questionnaire (1 out of 4 will benefit from this treatment and 49% in the experimental group showed clinically relevant change compared to 26% for the control group).  There were significantly different changes found in the IPQ-R for baseline and follow-up measurements between the control and experimental groups for 4 of the subscales: time line cyclical, consequences, personal control, and coherence.  There were no significant differences found for QBPDS (for general physical activities) which was expected since the focus was on specific tasks.

Limitations: The researchers only concluded on one limitation which was that they did not measure the long-term effectiveness of the treatment.