CBT begins by evaluating the pain, understand the negative thoughts and looks at practical ways to improve the patient's state of mind and acquire coping skills.

• Replacing unhelpful patterns with useful ones
  The negative thought and behaviour patterns are replaced with more sensible ones, as the therapist teaches participants about pain psychology, fear and avoidance issues, stress, depression and self-management of pain problems.

• Goal-setting & planning
  Patients may have goals such as returning to work, resuming exercise or carrying out household chores. These goals are broken down into smaller manageable steps so patients can pace themselves. Patients are also taught how to manage pain flare-ups and setbacks.

• Acquiring new skills
  Patients also learn coping skills, such as ways to calm their mind and body through relaxation, mindfulness and imagery. Problem-solving and communication skills can be taught as well.

Individual CBT sessions are generally attended on a weekly to monthly basis. A course of CBT lasts between 8 to 12 sessions.

CBT can also be conducted in a group setting, giving the participants the opportunity to learn from each other. At SGH, the pain management programme is multidisciplinary and involves physiotherapists, nurses and doctors. Lasting between 4 to 9 days, it is conducted in small groups of 5 to 10 patients, with follow-up group sessions after 1 month, 6 months and 1 year.

“Following CBT, patients find themselves more in control of their pain and their lives. Often they will feel the confidence and independence that had been lost, return. As they resume a more active and fulfilling life, their quality of life improves. Naturally the focus on the pain diminishes,” says Ms Tan.

Ref: S13