Pain management and behavioral therapy

Photo of group therapy

If fibromyalgia really affects your quality of life and daily routine, and if other treatments aren’t effective enough, multimodal pain management is an option. Cognitive behavioral therapy helps you to recognize thoughts and behaviors that make the pain worse, and then try to change them.

Chronic (long-term) pain can cause various problems, such as sleep problems and exhaustion. It can also greatly reduce your physical fitness and affect all areas of your life, including your relationships, family life, work, household chores, hobbies and recreational activities.

The pain often has an impact on your mood, too. Chronic pain can make people feel anxious – for instance, scared of moving too much or worried that the symptoms will keep on getting worse and increasingly dominate their life. Some people then become withdrawn and lose hope that things will get better. If the anxiety becomes overwhelming, it’s easy to fall into a vicious cycle of fears, feeling down, pain, sleep problems, exhaustion and worsening symptoms.

Because chronic pain can be caused by various things and affect many areas of life, it is often a good idea to use a combination of different treatments. This is where multimodal pain management comes in.

What is multimodal pain management?

In multimodal pain management approaches, doctors from different areas of specialization – including pain medicine, physiotherapy, occupational therapy and psychotherapy – work closely together. The treatment involves a combination of exercise, patient education, relaxation techniques and medication. Psychotherapists show patients psychological strategies that help them cope with chronic pain and stress at work or home. This is either done in groups or one-on-one sessions.

Multimodal pain management programs are mainly offered by pain centers, psychosomatic medicine departments in hospitals, and rehabilitation centers with a focus on rheumatology, orthopedics and psychosomatic medicine. In some programs you may stay at the hospital or center the whole time, and in others you may have some of the treatments as an outpatient. They last at least seven days, but usually two to four weeks.

The aim of the treatment is to “help people to help themselves” – in other words, learn strategies, exercises and techniques that they can use on their own once they go home.

Multimodal pain management is particularly suitable if other treatments haven’t helped enough or the fibromyalgia symptoms are having a great impact on the person’s quality of life or ability to function in everyday life. In Germany, the treatment can be prescribed by a practice-based doctor such as a family doctor, orthopedist or pain specialist. People generally have to wait about three months before they get a place in a multimodal pain management program.

What is cognitive behavioral therapy and when is it considered?

A lot of people who have fibromyalgia don’t understand how psychotherapy can help them because they think that it’s only used for the treatment of psychological problems. This isn’t true, though. For instance, one type of psychological treatment called cognitive behavioral therapy (CBT) is used in the treatment of tinnitus, sleep problems and various chronic pain syndromes.

Your own thoughts, feelings and behavior greatly influence how you experience chronic pain or other symptoms. For instance, some people find the pain to be far worse on a stressful day at work than they do at the weekend when they’re out and about with good friends.

The aim of cognitive behavioral therapy is to recognize negative thought patterns and behaviors that make the pain worse. You then try to change those thought patterns and behaviors, for instance by questioning the assumptions that the (often automatic) thoughts are based on. Multimodal pain management programs also include various techniques that can help people cope with pain, such as relaxation and stress management techniques, mindfulness training and visualization (guided imagery).

CBT can be particularly helpful in people who live in constant fear of pain, which actually makes the pain worse. It is also especially suitable for people with fibromyalgia who also have an anxiety disorder or .

Bernardy K, Klose P, Welsch P et al. Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome - A systematic review and meta-analysis of randomized controlled trials. Eur J Pain 2018; 22(2): 242-260.

Climent-Sanz C, Valenzuela-Pascual F, Martinez-Navarro O et al. Cognitive behavioral therapy for insomnia (CBT-i) in patients with fibromyalgia: a systematic review and meta-analysis. Disabil Rehabil 2021: 1-14.

Deutsche Schmerzgesellschaft. Definition, Pathophysiologie, Diagnostik und Therapie des Fibromyalgiesyndroms (S3-Leitlinie). AWMF-Registernr.: 145-004 (revised version). 2019.

Papadopoulou D, Fassoulaki A, Tsoulas C et al. A meta-analysis to determine the effect of pharmacological and non-pharmacological treatments on fibromyalgia symptoms comprising OMERACT-10 response criteria. Clin Rheumatol 2016; 35(3): 573-586.

Williams AC, Fisher E, Hearn L et al. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2020; 8: CD007407.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on May 24, 2022
Next planned update: 2025

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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