Before cognitive behavioral therapy (CBT) is recommended, a physician usually takes a medical history and conducts a physical examination. The patient is usually asked to describe pain symptoms in detail to determine whether physical ailments are the sole cause of pain, or whether emotional distress is contributing to it.

A physician may also ask the patient to describe other symptoms being experienced in addition to pain, such as:

• Fatigue
• Memory problems
• Irritable bowel
• Muscle tension
• Shortness of breath
• Palpitations
• Irritability
• Insomnia

Patients may also be asked to describe:

• Activities that have been altered by pain, such as sleep patterns
  
• Social support system, such as family and friends
  
• History of emotional, physical or sexual abuse

Identifying symptoms and circumstances that accompany pain can help a physician distinguish between physical and psychological aspects of pain.

Recent research suggests that a brain imaging technique called functional MRI could help identify which patients are more likely to benefit from CBT, such as those with decreased activity in a region called the subgenual cingulate cortex.

If CBT is recommended, patients will be referred to a therapist (a mental health professional such as a psychiatrist, psychologist or social worker). Prior to beginning therapy, a patient and therapist may meet for a consultation session during which the therapist assesses the patient, determines a course of treatment and discusses treatment goals with the patient.