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Our research, published in the Journal of Hand Surgery, reveals an opportunity to help patients cope with pain by engaging in cognitive behavioral therapy.
Millions of people in the U.S. have chronic pain in the hand, wrist, and/or thumb. Many benefit from cognitive behavioral therapy to help reduce this pain and restore function. However, our report, published in the Journal of Hand Surgery (American) with Dr. Casey Imbergamo as lead author, shows that most don’t know this non-medication approach is an option.
Arthritis is the most common cause of disability in the U.S., and osteoarthritis is the most common form of arthritis. Hand and wrist arthritis eventually develops for everyone in the joint at the base of the thumb, called the basal joint. As many as 1 in 5 adults, most of them female, will go to a provider for basal joint arthritis in their lifetime. It can cause debilitating symptoms, including:
- A bump on the joint or an enlarged appearance
- Limited range of motion or loss of strength
- Pain at the base of the thumb when gripping or pinching
- Pain in the heel of the hand
- Swelling and tenderness at the base of the thumb
MedStar Health Research Institute and Curtis National Hand Center are conducting a series of studies to help us better understand how to help people with this standard and painful condition. Our recent work sheds light on cognitive behavioral therapy’s (CBT) role in helping patients with basal joint arthritis and other painful hand and wrist conditions.
Survey: 13 questions about patient experience with CBT.
To understand what patients know about CBT, we published a report titled “Patient Perspectives on Cognitive Behavioral Therapy for Thumb, Hand, or Wrist Pain and Function: A Survey of 98 Patients.”
In spring 2022, we surveyed more than 300 MedStar Health patients diagnosed with arthritis or non-specific hand, thumb, or wrist pain. We asked them to answer 13 questions about their experiences with, and understanding of, CBT.
Of the 98 people who responded, nearly half (42) said they had never heard of CBT, and 16 said they didn’t know enough about the therapy. However, all patients who did use CBT for arthritis said they felt it was helpful. Other insights included:
- 17 said they use CBT to help with pain and functionality
- Of those, 15 felt CBT could also help others
- 28 said CBT had not been recommended to them as an option for pain
- Few patients indicated they thought CBT was too expensive or time-consuming or that they didn’t think it would help.
Our findings suggest that if more people were offered CBT, more could benefit from pain reduction and functionality improvements. Spreading education and reducing stigma around mental health care are essential next steps.
Related reading: Several Treatments Can Relieve Hand Pain Caused by Osteoarthritis.
CBT works to help patients with hand pain.
Cognitive behavioral therapy can help patients reframe negative thoughts, calm the body’s response to pain, and break the cycle that makes pain worse. Working with a psychologist or psychiatrist, patients learn that while their pain is real, it is possible to restructure their expectations, thoughts, and emotions about the pain.
Acknowledging the pain and finding ways to calm the body’s response can help lower blood pressure and heart rate while relieving emotional reactions like fear and stress that worsen the pain. Studies have shown reductions in pain of up to 30% among people who use CBT to help them cope with chronic pain.
Dr. Natasha Durant and her colleagues use CBT with patients to help them manage their pain. She contributed to the report we recently published. A combination of CBT, braces, hand therapy, medications, and other treatment options often allows patients to find relief. Patients frequently reduce or eliminate their use of medications or other modalities as CBT progresses.
Patients typically conclude CBT after four to eight weeks with a new set of tools to help them navigate the challenges of chronic pain, with further follow-up appointments as necessary.
To help patients learn about and access CBT, it is crucial that more patients get regularly screened for mental health conditions and that CBT is offered and discussed as a pain management option. Our Research Director, Dr. Aviram Giladi, is helping us make this a more routine part of our research and clinical care.
