(Author) By Kevin L. Zacharoff, MD, FAAP, FACPE, FACIP
Education is a key component of effective pain management. Many people with chronic pain often lack understanding about their condition and in many cases doubt their ability to play a significant role in the management of their pain. This can contribute to a variety of poor outcomes
including increased pain, pain-related disability, and ultimately a lower quality of life.
While information is necessary, information alone is insufficient to activate patient engagement in appropriate self-management. Self-management approaches are intended to integrate synergistically with standard medical approaches. Self-management training can provide patients with skills that help coordinate tasks needed to manage their pain, and help them keep active in their day-to-day lives. Additionally, self-management training can help foster more effective collaboration between patients and their healthcare providers, increasing the likelihood of patients discussing their pain management methods with their medical providers.
The primary objectives of self-management programs are to provide patients with information and skills that enhance their ability to participate in their health care (e.g., communicate with providers, identify relevant information, and adhere to treatment). Patients benefit from support and guidance that helps them master the skills required to minimize “breakthrough” pain, while optimizing mood and functioning. Specific skills based on a cognitive behavioral model offer excellent utility in meeting those needs, including:
- The ability to interpret and relay changes in pain in a meaningful and contextual way
- Engagement in pain reducing and health-promoting behaviors
- Development of action plans for anticipating and coping with pain exacerbations
A central element in a self-management approach is to help patients understand the impact that living with pain may have on their emotions, daily activities, and relationships. Many self-management techniques can alter the subjective experience of pain and the psychosocial influences on pain. Beliefs about pain, fears of harm, avoidance responses, ideas about the origins of pain, and expectations of treatment, self-efficacy, and coping, are some of the factors that influence behavioral responses to pain. All of these are important targets of psychosocially oriented self-management approaches. Three of the most important psychological targets for self-management intervention are:
- Anxiety and Fear – common in people with chronic pain so it is essential that patients receive adequate information to allay fears and reduce psychological distress.
- Pain Catastrophizing – a pattern of negative thoughts about actual or anticipated pain, including rumination, magnification, and helplessness.
- Environmental Factors – play a large role in the direct and indirect reinforcement of pain behavior, making it necessary to help
patients recognize if they are getting a secondary gain for their pain behavior.
When providing information to patients, it is important to consider health literacy as a component of a comprehensive self-management approach. Patients’ capacity to seek, understand and utilize health information to make decisions about their health is an important determinant of how much they can participate in their care. When patients know when to seek medical help, how to effectively communicate with their providers, how to adhere to treatment, and how to make use of other health services and supports, they are able to self-manage their pain to a much higher degree. Teaching chronic pain patients how to set goals, assess their progress, and solve problems on their own are all important components of effective self-management.
From a behavioral perspective, pain outcomes, and the quality of the patient-provider partnership, can be enhanced when self-management training includes the following:
- Behavioral skills with demonstrated efficacy in mediating outcomes
- Education about the environmental and psychological factors that directly and indirectly influence the maintenance of pain behavior and symptoms
- Tools for patients to collect, organize, and reliably report meaningful clinical data to their providers
- Reinforcement of the idea of patient responsibility in the context of a collaborative approach to maintaining health and managing pain
Another way to help patients become better pain self-managers is to gather your own “evidence” about patient self-management. Ask your current patients who are “successful self-managers” what information was helpful to them when they first started experiencing chronic pain, what information is helpful now, what are they looking to learn and would like to know, and what problems have they frequently encountered. This
information will help you fine tune the self-management approach you use with your patients.
In summary, the coordination and integration of self-management initiatives into patient care offers the potential to enhance the patient-provider relationship and improve outcomes. Addressing key psychosocial targets via self-management skills training can help
chronic pain patients develop an improved ability to confidently manage pain and pain symptoms. Patients able to self-manage their pain lead
healthier, more active lives, allowing them greater self-efficacy and well-being. Remember that if you want to help your patients engage in self-management and get the most out of their efforts, your self-management training approach should:
- Be personalized – tasks should be unique for each patient depending on symptoms, personal characteristics, lifestyle, and progress over time.
- Address emotional coping issues – emotions can affect the perception of pain; negative emotions are common in those with chronic pain.
- Emphasize an active role- set the expectation that your patients are partners in managing their condition within the context of the patient-provider partnership.
- Build confidence and skill – use knowledge in the service of building skills and activating patient participation.
- Consider cultural issues – health behavior is connected with culture, so effective self-management messages need to be attuned to the relevant cultural issues.
Dr. Zacharoff is the Director of Medical Affairs at Inflexxion, Inc., developer of educational websites painACTION and painEDU.org, resources for clinicians, health educators and patients to enhance their understanding of pain management. Dr. Zacharoff is a licensed, Board Certified, Anesthesiologist with more than 25 years of clinical experience in Anesthesiology and Pain Medicine. Dr. Zacharoff provides clinical guidance and content for http://www.painaction.com and painEDU.org and is co-author of the Inflexxion Health Series publications.
