An outpatient program based on cognitive behavioral therapy and physical exercise improved pain self-management for patients with complex pain, according to a study published in Pain Research Management.

Edward Robinson, MD, from Bridgepoint Health and the University of Toronto, and colleagues examined the outcomes of the pain self-management program at a rehabilitation hospital in Toronto. The program consisted of 20 sessions for 10 weeks that focused on education, cognitive behavioral skills, exercise, and self-management strategies.

Thirty-six pain management groups were held between 2002 and 2011. Overall, 311 patients entered the program and 214 completed it. The main outcome measures of the study were the sensory, affective and intensity of pain experience, depression, anxiety, pain disability, active and passive coping styles, and general health functions.

Continue Reading

Using pretreatment and posttreatment questionnaires, the researchers observed statistically significant changes toward improved health among the patients who completed the program. There were also significant decreases in scores for depression, anxiety, and pain disability.

The researchers found that all of the outcome measures had a statistically significant effect of time in the direction of improved health, except for some subscales of general health, which showed nonsignificant changes.

The investigators note that the goal of these programs is not specifically to decrease pain, because the participants have all experienced chronic pain lasting for more than 6 months and have tried numerous approaches to decrease their pain with poor results. Therefore, this group of patients has a poor prognosis for the elimination of their pain. However, patients who learn to manage their pain can improve their mood and quality of life, as well as reduce pain levels.

“The most significant changes occurred in mood (improved levels of depression and anxiety) and in a shift to employing active vs passive coping strategies,” the researchers concluded. “These results are consistent with previously reported benefits of CBT [cognitive behavioral therapy] for chronic pain patients and in programs that combine CBT with physical exercise. While there was a decrease in pain levels, this was less noticeable. This is consistent with previously reported outcomes of other similar CBT pain management programs.”


  1. Boschen KA, Robinson E, Campbell KA, et al. Results from 10 years of a CBT pain self-management outpatient program for complex chronic conditions. Pain Res Manag. 2016. doi: 10.1155/2016/4678083.