Type of Article:  Original Research

Volume 11; Issue 4 (August 2023)

Page No.: 4589-4597

DOI: https://dx.doi.org/10.16965/ijpr.2023.139

Awareness, Beliefs and Practice of Cognitive Behavioral Therapy (CBT) Strategies for Chronic Pain Management Among Physiotherapists

Neha Biyala*1, Joshua Samuel Rajkumar 2, Mahita ThangaduraI Rajendran 3.

*1 Consultant Physiotherapist, JOSH Clinic, Bangalore, Karnataka, India.

2 Consultant Physiotherapist, JOSH Clinic & Astra Rehabilitation Hospital, Bangalore, Karnataka, India.

3 Consultant Psychologist, Astra Rehabilitation Hospital, Bangalore, Karnataka, India.

Corresponding Author: Dr. Neha Biyala, Consultant Physiotherapist, JOSH Clinic, Bangalore, Karnataka, India. E-Mail: nehab40299@gmail.com


Purpose: To evaluate the awareness, practice and beliefs about CBT strategies for chronic pain management among Physiotherapists.

Relevance: Chronic pain can be defined as pain that persists for 3 months or longer and, while not necessarily maladaptive, often leads to physical decline, limited functional ability and emotional distress. CBT has been increasingly used as an effective tool by psychologists in the management of chronic pain that is delivered through individual or group counselling sessions. Cognitive restructuring, relaxation techniques, activity pacing and good sleep hygiene are a few strategies of cognitive behavioral pain management therapies. There is also increasing evidence that supports the use of CBT strategies by Physiotherapists during their treatment for obtaining a positive outcome for chronic pain patients.

Method and Analysis: A Google Form was formulated with relevant questions about awareness, practice and beliefs about CBT strategies for chronic pain. The questionnaire was face validated by 3 independent psychologists who practice CBT for chronic pain in their regular practice. This form was then distributed through various Physiotherapy groups in Bangalore via snowball sampling method. The data obtained from the responses were then complied, decoded and quantitatively analysed through content analysis using the SPSS-22.

Result: The result showed strikingly contrasting responses from the Physiotherapists, as even though the majority of them were aware of CBT (34.1%), they applied it relatively less (15.3%). Of 63.5% Physiotherapists believed that pain perception is affected by automatic thoughts, while 52.9% agreed that negative thoughts need to be changed into positive coping thoughts. Around 49.4% of Physiotherapists believe in teaching relaxation techniques to their patients with chronic pain. Activity pacing and good sleep hygiene are important, as believed by 25.9% and 47.1% respectively. Physiotherapists (56.5%) accepted that patient needs to be mindful while exercising.

Conclusion: Majority of Physiotherapists are aware and have positive beliefs about CBT strategies for chronic pain management. However, comparatively, we can see variations in the application of CBT strategies in their treatment plan.

Key Words: Cognitive Behavioral Therapy, chronic pain, Physiotherapy.


[1]. Smith, B. H., Fors, E. A., Korwisi, B., Barke, A., Cameron, P., Colvin, L. & Treede, R. D. The IASP classification of chronic pain for ICD-11: applicability in primary care. Pain, 2019;160(1):83-87.
[2]. Ehde, D. M., Dillworth, T. M., & Turner, J. A. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. American Psychologist, 2014;69(2):153.
[3]. Leong, I. Y., Farrell, M. J., Helme, R. D., & Gibson, S. J. The relationship between medical comorbidity and self-rated pain, mood disturbance, and function in older people with chronic pain. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2007;62(5):550-555.
[4]. Tripp, D. A., VanDenKerkhof, E. G., & McAlister, M. Prevalence and determinants of pain and pain-related disability in urban and rural settings in southeastern Ontario. Pain Research and Management, 2006;11(4):225-233.
[5]. Arnow, B. A., Hunkeler, E. M., Blasey, C. M., Lee, J., Constantino, M. J., Fireman, B., … & Hayward, C. Comorbid depression, chronic pain, and disability in primary care. Psychosomatic medicine, 2006;68(2):262-268.
[6]. Reid, M. C., Williams, C. S., & Gill, T. M. The relationship between psychological factors and disabling musculoskeletal pain in community‐dwelling older persons. Journal of the American Geriatrics Society, 2003;51(8):1092-1098.
[7]. Reid, M. C., Guo, Z., Towle, V. R., Kerns, R. D., & Concato, J. Pain-related disability among older male veterans receiving primary care. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2002;57(11):M727-M732.
[8]. Blyth, F. M., March, L. M., Brnabic, A. J., & Cousins, M. J. Chronic pain and frequent use of health care. Pain 2004;111(1-2):51-58.
[9]. Turk, D. C. Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. The Clinical journal of pain 2002;18(6):355-365.
[10]. Hopman-Rock, M., De Bock, G. H., Bijlsma, J. W., Springer, M. P., Hofman, A., & Kraaimaat, F. W. The pattern of health care utilization of elderly people with arthritic pain in the hip or knee. International Journal for Quality in Health Care, 1997;9(2):129-137.
[11]. Saxena, A. K., Jain, P. N., & Bhatnagar, S. The prevalence of chronic pain among adults in India. Indian journal of palliative care, 2018;24(4):472.
[12]. Attal, N., Lanteri-Minet, M., Laurent, B., Fermanian, J., & Bouhassira, D. The specific disease burden of neuropathic pain: results of a French nationwide survey. Pain 2011;152(12):2836-2843.
[13]. Knoerl, R., Lavoie Smith, E. M., & Weisberg, J. Chronic pain and cognitive behavioral therapy: An integrative review. Western journal of nursing research 2016;38(5):596-628.
[14]. Barry, L. C., Gill, T. M., Kerns, R. D., & Reid, M. C. Identification of pain-reduction strategies used by community-dwelling older persons. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2005;60(12):1569-1575.
[15]. Barry, L. C., Kerns, R. D., Guo, Z., Duong, B. D., Iannone, L. P., & Carrington Reid, M. Identification of strategies used to cope with chronic pain in older persons receiving primary care from a Veterans Affairs Medical Center. Journal of the American Geriatrics Society, 2004;52(6):950-956.
[16]. Kerns, R. D., Otis, J. D., & Marcus, K. S. Cognitive-behavioral therapy for chronic pain in the elderly. Clinics in geriatric medicine, 2001;17(3):503-523.
[17]. Melzack, R., & Wall, P. D. Pain Mechanisms: A New Theory: A gate control system modulates sensory input from the skin before it evokes pain perception and response. Science 1965;150(3699):971-979.
[18]. Melzack, R. From the gate to the neuromatrix. Pain, 199;82:S121-S126.
[19]. Turk, D. C., Meichenbaum, D., & Genest, M. Pain and behavioral medicine: A cognitive-behavioral perspective (Vol. 1). Guilford Press 1983.
[20]. Wandner, L. D., Prasad, R., Ramezani, A., Malcore, S. A., & Kerns, R. D. Core competencies for the emerging specialty of pain psychology. American Psychologist, 2019;74(4):432.
[21]. Kerns, R. D., Sellinger, J., & Goodin, B. R. Psychological treatment of chronic pain. Annual review of clinical psychology, 2011;7:411-434.
[22]. McCurry, S. M., Logsdon, R. G., Teri, L., & Vitiello, M. V. Evidence-based psychological treatments for insomnia in older adults. Psychology and aging, 2007;22(1):18.
[23]. Legrain, V., Van Damme, S., Eccleston, C., Davis, K. D., Seminowicz, D. A., & Crombez, G. A neurocognitive model of attention to pain: behavioral and neuroimaging evidence. PAIN®, 2009;144(3):230-232.
[24]. Riva, P., Wirth, J. H., & Williams, K. D. The consequences of pain: The social and physical pain overlap on psychological responses. European Journal of Social Psychology, 2011;41(6):681-687.
[25]. Driver, C., Lovell, G. P., & Oprescu, F. Physiotherapists’ views, perceived knowledge, and reported use of psychosocial strategies in practice. Physiotherapy theory and practice 2019.
[26]. Semmons, J. The role of physiotherapy in the management of chronic pain. Anaesthesia & Intensive Care Medicine, 2019;20(8):440-442.
[27]. Beissner, K., Henderson Jr, C. R., Papaleontiou, M., Olkhovskaya, Y., Wigglesworth, J., & Reid, M. C. Physical therapists’ use of cognitive-behavioral therapy for older adults with chronic pain: a nationwide survey. Physical Therapy, 2009;89(5):456-469.
[28]. Law, E. F., Kim, A., Ickmans, K., & Palermo, T. M. Sleep health assessment and treatment in children and adolescents with chronic pain: State of the art and future directions. Journal of Clinical Medicine, 2022;11(6):1491.
[29]. Nijs, J., D’Hondt, E., Clarys, P., Deliens, T., Polli, A., Malfliet, A., ..& Ickmans, K. Lifestyle and chronic pain across the lifespan: an inconvenient truth?. Pm&r, 200;12(4):410-419.


Cite this article: Neha Biyala, Joshua Samuel Rajkumar, Mahita ThangaduraI Rajendran. Awareness, Beliefs, and Practice of Cognitive Behavioral Therapy (CBT) Strategies for Chronic Pain Management Among Physiotherapists. Int J Physiother Res 2023;11(4):4589-4597. DOI: 10.16965/ijpr.2023.139