Guest Blog by Chris Lendrum: Physiotherapist and Personal Trainer at Jones Fitness in Biggleswade.

CBT and exercise: a marriage made in heaven for chronic pain.

Chronic pain can be a debilitating condition, which really takes its toll on people’s mental health and ability to enjoy their lives.

This article will talk about the massive benefits that CBT alongside exercise can have to help those with chronic pain and why this is.

It will also give you strategies that can hopefully help you if you are experiencing chronic pain.

Chronic pain affects a large amount of people in the UK and around the world.

According to the world health origination it is a big cause of people taking time off work and has a significant effect on people’s mental health.

“Chronic pain is one of the most underestimated health care problems in the world today, causing major consequences for the quality of life of the sufferer and a major burden on the health care system in the Western world” – Professor Harald Breivik, President of EFIC

The amount of times I see patients who are in tears when they tell me about how much their pain is affecting their lives is scary and also very sad.

Chronic pain is a complex condition, but I want to set the scene slightly by trying to explain the term in its simplest way.

Chronic pain or “persistent pain” as it is sometimes now called is a pain that someone has over and above the normal time frame of healing for soft tissue injury. So basically, anything over three months can be classed as persistent pain.

Other people might also state that chronic pain is a condition where the source of pain has been investigated and no physical source can be found.

This is a very biomedical way of looking at pain though, finding a “source” suggests you just need to find the source and then you can find the cure and pain is much more complicated than this.

Persistent pain has a profound effect on the nervous system and has been researched extensively and we now know that even though a muscle or joint or ligament may not be the cause of pain the central nervous system can be.

Essentially the nervous system can feel threatened and this feeling can manifest as pain.  Feelings of the system being threatened can be caused by physical stress (broken bone) or psychological stress (feelings of anxiety, stress etc.) or social stress (worrying about supporting a sick family member if injured, worrying about performing work related tasks)

I am not going to go too in depth about chronic pain as this is a massive topic itself but there are a few great YouTube videos that I would recommend here:

So, we know that chronic pain is complex but how do we go about making it better? After all that’s the main reason you are reading this article, right?

Well, one of the ways that chronic pain has been successfully treated is with the combination of CBT and exercise.

But wait what is CBT?  I’m sure if you are reading this blog then you will have an awareness of what CBT is but for those who might not be familiar CBT stands for cognitive behavioral therapy.

It is a way of looking at situations by taking into account how your thoughts affect your behavior and in turn how your behavior affects your thoughts.

A cognitive behavioral therapist will take you through a process of you exploring your own thoughts and feelings around different areas of your life and then guiding you to an understanding of how these things can affect you.

In this way, you are creating your own road map in your mind as to what you might need to do to overcome or aid in reversing the issue.

As an example, let’s discuss chronic lower back pain.

You might be fearful of movement as you feel that this will make your back worse.

This fear of movement (thoughts) leads to less movement (behavior) and the body becoming stiffer thereby making movement even harder.

Then when you try to move the body and back hurts more so it is a self-fulfilling prophecy. You feel you were correct in your original analysis and therefore move less and the problem gets even worse.

If we reverse this and think, what if you were to do a very small amount of motion that was not aggravating for your back, this would keep the muscles and joints moving and after doing this would likely not cause pain.

This would reinforce to the brain that it was “OK to move” and then you would be more inclined to do a bit more, gradually over time this would lead to more movement, less stiffness and less pain getting you on the road to recovery.

Equally if we look at the lower back from another standpoint, you might be worried about caring for a loved one.

The thoughts of not being able to care for the loved one lead to anxiety and this leads to stress and worry which in turn leads to tension in the body and more pain.

By working through the thoughts and feelings around caring for your loved one, you can start to realize that the thought does not create a behavior that helps you in any way.

By choosing a behavior that might say facilitate some help from other family members, involve social care more etc. you are actively finding solutions that can alleviate some of the psychological stress of the situation and often in turn reduce pain.

These are just some examples of how CBT can be useful in chronic pain situations but obviously every patient is different with different issues and different needs.

Talking to an experienced CBT practitioner (Like Sally!) will enable you to be guided towards what things might be having an impact on your life and help you to work towards resolving these issues.

So we have seen a brief example of what CBT is and an example of how it can be used but what does the research say about it with regards to chronic pain.

Well it says its good, very good in fact.

And it’s even better if added with exercise as well!

Research tends to suggest that CBT is very effective for dealing with chronic pain disorders.

Does it cure them all?

Well no it doesn’t but there is at this time of writing no panacea for chronic pain, but CBT and exercise do a very good job of reducing pain.

A study by John McBeth entitled Cognitive Behavior Therapy, Exercise, or Both for Treating Chronic Widespread Pain (2012) looked at a total of 442 patients with chronic pain.

There were 4 different groups of patients randomized to receive 6 months of TCBT (telephone CBT), graded exercise, combined intervention (CBT and exercise), or treatment as usual (TAU).

What they found was that the most successful group was the combined CBT and exercise group.

Now looking at the study the outcome was still only nearing on 40% positive in the CBT plus exercise group, which one might say is disappointing, but when you consider the treatment as usual group scored near 10 percent positive outcome this is a massive difference!

The combination of CBT and exercise is great as was shown in the previous article as it really takes into account the whole person’s needs.

It does not just pigeon hole people into small boxes and really gets the patient to explore their own issues and work towards a resolution themselves. 

There are lots of other studies out there that show a similar pattern 

A systematic review by Brunner et al (2012) concluded that operant conditioning can be integrated in physiotherapy practice and is a promising CBT-based strategy for the prevention of chronic lower back pain.

What these two along with other studies show is that CBT alongside exercise should be considered when it comes to the treatment of chronic pain conditions.

Finally, if you have been reading this article and are now thinking “That’s great and it all sounds good but what can I do now, I’m in PAIN!”  The key takeaways that I would like you to consider are as follows.

Chronic pain is common, and you can get through it.

With the right guidance and support you will be able to improve your situation and seeking the help of someone trained in CBT alongside a physiotherapist who can help with exercise would be ideal to help your problem.

In terms of an action plan that you can start to implement here are a few top things to think about.

  1. Try to get in some regular exercise a few times a week.
  2. If you have chronic pain seek help from someone who has CBT training.
  3. Seek help from a physiotherapist alongside a CBT practitioner for maximum effectiveness.
  4. There are large bio-psychosocial effects on the body, and these can cause pain so think about dealing with these issues through CBT or talk therapies.
  5. Don’t feel like you need to suffer in silence.
  6. Chose a type of exercise that you enjoy as consistency is the key element.
  7. Start to explore how your thoughts might be affecting your behavior, how might changing these thoughts affect your behavior and equally how might changing your behavior affect your thoughts?

So, there you have it, a quick article on how CBT and exercise can help with chronic pain.

Obviously, CBT also has a massive role to play in other disorders like anxiety, depression along with many others but that is outside the scope of this article alone.

It’s a fantastic tool that can be used to help patients with all types of conditions and really make a positive impact on their lives.

Hopefully the article has helped, if you have any questions or are suffering and want to reach out my website is here 

Please don’t hesitate in getting in touch.

Obviously with the CBT side of things reach out to Sally as she is an expert who can help!

Thanks for reading



Brunner E, e. (2019). Can cognitive behavioural therapy based strategies be integrated into physiotherapy for the prevention of chronic low back pain? A systematic review. – PubMed – NCBI. [online] Available at: [Accessed 20 Jun. 2019].

McBeth, J., Prescott, G., Scotland, G., Lovell, K., Keeley, P., Hannaford, P., McNamee, P., Symmons, D., Woby, S., Gkazinou, C., Beasley, M. and Macfarlane, G. (2019). Cognitive Behavior Therapy, Exercise, or Both for Treating Chronic Widespread Pain.

Sally Otto


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Sally Otto Therapy Bedfordshire
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