FEATURE STORY / CBT and Chiropractic
T
his is going to sound
familiar. A patient walks
back into your office
looking discouraged.
Following several
treatments and in spite of your strong
encouragement that the patient take their
treatment plan seriously and personally,
they are not improving. This leads you
to question your approach. It might
even lead you to throw up your hands or
consider referring the patient to another
chiropractor.
This is the moment to stop. The
elements of the treatment plan you are
implementing may be perfect. There just
might be a missing link.
One of the hallmarks of this profession
is that chiropractors pride themselves on
seeing the whole person when they walk
through the door. This is demonstrated
by the amount of time and attention
patients receive in most chiropractic
clinics. Recently, scholarship and evidence
are indicating that now is the time to
intensify the focus on the whole patient by
adopting some psychological therapeutic
techniques into chiropractic treatment
plans. This is based on the long understood
connection between mental health and
pain, particularly chronic pain. The new
piece of this puzzle is that recent research
has demonstrated that even a relatively low
level of Cognitive-behavioural Therapy
within a treatment plan can positively
impact patient outcomes.
Emotional & Physical Pain
T
he connection between pain and
mental health issues, depression
in particular, has been established
for some time. An article published last
year in the journal Current Psychiatry
Reports,b stated that the instance of
10
SPRING 2014
comorbid depression being experienced
by pain patients was between 30 and
60%. The reverse relationship also exists.
About 50% of depression patients report
comorbid pain conditions. Pain patients
with comorbid depression experience
greater pain, a worse prognosis and greater
functional disability. They also tend to
experience higher health care costs. These
findings were reported based on a review
of extensive literature which “leaves little
question that pain and depression often
present together and when they do cooccur the cost is significant.”b
The article also provides a summary
of recent thinking on why pain and
depression are associated. The connection is
neurobiological. The human body processes
pain using a complex multidimensional
pain system. Some have thought that
psychological pain differs from physical
pain because it does not involve specific,
external bodily stimuli. Advancements in
neuroimaging have allowed researchers
to identify a number of structural regions
of the brain that are associated with both
types of pain. The areas most associated
with this overlap are the anterior insula,
prefrontal cortex, anterior cingulate cortex
and thalamus.b
An example may clarify the
connection. An fMRI study was conducted
of fibromyalgia patients with and without
comorbid depression. The fMRI measured
the response in the patients’ brains to
painful external stimulus. Both groups
had similar responses, but the group with
comorbid depression had a much stronger
response to the stimulus in the areas of
the brain believed to be associated with
processing pain, such as the amygdala and
the anterior cingulate regions.b
By the Numbers:
1in8
1 in 8 Canadian adults
(12.2%) identified symptoms
that met the criteria for clinical depression at some point
during their lifetime. (Public
Health Agency of Canada)
30%
to
60%
Percentage of pain patients
who reported comorbid
depression in a 2013 study.
50%
Percentage of depression
patients who reported
comorbid pain conditions
in a 2013 study.