Benefits of behavioral therapy: understanding and overcoming chronic pain

Chronic MSK Pain can be Intimidating

Andrew (name changed) had recently received the results of an MRI, and his doctor had noticed some disc degeneration in his spine. He was feeling confused by his results, stressed about his back pain, and hopeless. It felt like his back pain would never go away, no matter what he tried.

Andrew is one of 5,000 members at TTX Company, a provider of railcars and related freight car management services to the North American rail industry. He works in the Audit Department and is a self-described workaholic who has been with the company for 16 years. Spending half of his time in the field wearing lots of heavy gear and heavy lifting, he first noticed his back pain 7 years ago and had come to believe that pain just comes with the job.

For the past 8 months, Andrew had noticed significant changes in his lifestyle. He found himself avoiding his normal gym routine out of concern for the pain he knew would come as a result of a workout. He was having depressing thoughts, increased worry, and fear of pain began to affect his quality of life.

Half of Americans suffer from musculoskeletal pain, and chronic sufferers like Andrew often feel resigned to their pain, hopeless that they will get better. This can lead to unhealthy behaviors that can prolong or exacerbate their pain. That’s where behavioral therapy comes into play.

There are three main pillars that are proven to be most successful in treating chronic musculoskeletal pain: exercise therapy, education, and behavioral health. This article will wrap up the blog series on these three pillars by digging into behavioral health and why it is critical to managing chronic pain.

Behavioral Therapy Helps Identify Thought Patterns

Unhelpful thought patterns can arise and lead to behavioral changes such as isolating yourself or not socializing. For Andrew, an example of an unhelpful thought pattern would be his hopelessness at improving his pain. It’s not uncommon to feel discouraged by pain that seems never-ending, but just like Andrew, you have lots of tools at your disposal.

Falling under the umbrella of psychotherapy (also known as talk therapy), cognitive behavioral therapy (CBT) is an incredibly effective way to identify unhelpful thought patterns, beliefs, and feelings. By recognizing these methods of thinking, you are much better equipped to make changes, overcome challenges, and understand your chronic pain.

Behavioral Therapy Helps You Take Back Control

In addition to unhelpful thought patterns, fear avoidance often presents with chronic MSK pain. Chronic pain can cause avoidance of movements or activities that have been associated with pain. In Andrew’s case, he began to avoid the gym. However, fear avoidance could also apply to a specific behavior, such as taking the stairs at work. Over time, it is common to become conditioned to avoid or fear things such as a gym routine, or stairs, because the activity becomes associated with pain.

Behavioral therapy helps you modify your thoughts and behaviors to reach your goals, whether it’s going to the gym 3 days a week, or being able to hike again. By providing a clear outlook on what you want to change, behavioral therapy offers a path to overcome any challenges that might stand in the way. Goal setting is one method that is proven to be successful in improving MSK pain. Goal setting allows you to have something to strive for and track your progress towards.

The SMART goal method is a highly effective way to construct a goal.

• Specific - is what you want to accomplish clear?

• Measurable - how will you keep track of your progress?

• Attainable - is your goal realistic and achievable for you at this time?

• Relevant - is this goal going to get you where you want to be?

• Timely - what kind of timeline do you have set for this goal?

This method provides the necessary clarity, accountability, and motivation necessary to be successful in achieving your goals. It is also important to set both short-term and long-term goals. Short-term goals are an excellent way to build self-efficacy, and maintain motivation by reminding you what you are capable of achieving. Long-term goals help you think about where you want to go in the more distant future, and allow you plenty of time to get there.

It is important to set behavior-driven goals to focus on changing behaviors that you have control over. These types of goals help build control back into your life and overcome the hopelessness and avoidance of activity that those suffering from chronic pain often experience. Note that this is different from an outcome-driven goal, which is not directly related to control and self-efficacy. For example, a behavior-driven goal would be “brushing teeth every day” whereas an outcome-driven goal would be “reduce the number of cavities I get.”

Behavioral Therapy Helps You Build Healthy Habits

A key step to reaching your goals is building healthy habits. Habit formation is the bridge that will get you to your goals. Taking care of your physical health in an effective way starts in your brain. By cultivating healthy habits, you are “rewriting” a version of yourself - one with reduced MSK pain!

Building a successful habit does not have to be complicated. The goal is to train yourself to perform a healthy behavior as an automatic response to some sort of cue, or trigger. A simple example of a healthy habit is brushing your teeth - this feels like a natural part of your daily schedule, but in reality it is a learned behavior. By performing this action on a regular basis, it becomes a habit. The same can be done with exercise therapy.

Health Coaches Provide Support, Motivation, and Accountability

Behavioral health is a critical component to reducing chronic pain because it helps you change unhealthy thoughts and behaviors. Combined with exercise therapy and education, they work together to treat the whole person and form the three pillars of non-invasive preventative MSK care.

Andrew discovered that his employer, TTX, was offering the Hinge Health program to its employees. Hinge Health is a digital care program founded on all 3 pillars of best-practice MSK care: exercise therapy, behavioral health, and education. Each participant has unlimited 1-on-1 access to their own health coach, who provides support, motivation, and accountability. Having a support system is important to any lifestyle change, especially when it comes to your MSK pain. Hinge Health coaches are specifically trained to help you identify your goals, overcome any challenges you might face, and build healthy habits.

“Back pain is definitely not what it once was - it’s no longer a struggle to get out of bed, commute... those every day struggles are just not there.”

Andrew was still concerned about his back pain, but felt much more confident in his options for managing pain, and was willing to commit to his exercise therapy. Andrew’s ability to stick with the program and regain confidence in managing his pain is an excellent example of how behavioral therapy is a key piece of the puzzle to reducing chronic MSK pain.

Want to hear how Blue Cross NC, Nielsen, and US Foods tackled high musculoskeletal spend with the 3 pillars of best-practice care? Join us on September 26th for an executive roundtable designed for Benefits, Health, and Wellness Executives.