This is a standard approach to pain management in many countries around the world. The therapy deals with the two essential aspects of every person: cognition is the power to think and understand, behavior is all the acts and omissions we want to happen. Let’s deal with the thinking part first. The key factor supposed to distinguish humans from the animals is the ability to think. Although there is evidence of some intelligent behavior from some animals, we are the only species to develop language and a clear power to think in abstract terms. This makes us the superior species. But it does not come without costs. Because we do think about life, the universe and everything, we can talk ourselves into being happy or just as easily find reasons to be unhappy. The mind is a powerful tool for controlling the body and, in some, it causes or aggravates existing physical problems. Anticipation or fear can exaggerate our senses and make even a small injury seem severe. Panic and hysteria can amplify pain. A calm state of mind sees an injury for what it is and plans how to make the best of the situation. In other words, how well or badly people react to pain is a reflection of whether they are positive or negative. Ignoring the heroes, one of the characters we admire is the stoic — the person who shows courage and patience in the face of danger, pain and suffering. This is not mere indifference to pain. It’s a commitment to live life well despite it.

As to behavior, this follows on from the mind. If we take a disease like arthritis, there is no cure. Some treatments can give a little relief, but you are never going to get better. So, if you decide not to give up and fight for a better life, the question is how you should behave. The answer lies in learning how to move to get things done, but without increasing the pain. So, for example, if you have arthritis in your shoulder joint and it is painful to lift your arm above the level of your shoulder, you have to design your living space so that everything is reachable below that level, and learn to wash yourself, dress and do all the routine things without lifting your arms. Experts teach you how to regain mobility without aggravating the pain. These are practical coping strategies, not some book theories. If you want to learn how to move, these therapists can teach you how.

CBT helps people keep a positive view of the world and learn how to live within the new physical limits. It does not remove the need for some pain relief from the excellent drugs like tramadol. There will still be a need for these drugs when pain unexpectedly flares up. But the intention is to build a new quality of life in which you control your mind and behavior to continue living without becoming dependent on tramadol or its equivalent. This avoids the continuing cost of buying the drugs and the sometimes unfortunate withdrawal symptoms if you stop taking them suddenly. Pain management through the power of your own mind is the best way.