How Chronic Pain Impacts Self- Management
With almost one in five adult Americans experiencing persistent pain for longer than three months, chronic pain is one of the foremost public health issues that physicians wrestle with. Most of the public improperly believes that chronic pain can be remediated with medications, but the medical community has moved away from freely prescribing dangerous medications like opioids.
Instead, medical experts are recommending a multimodal approach that is more sustainable in the long term. This may involve physical therapy, cognitive retraining, dietary changes and lifestyle adjustments. This self-management approach requires a strong commitment and energy investment, but the outcome for the patient is almost always superior to a purely pharmacological therapy.
What Is Self-Management for Chronic Pain?
As the term implies, self-management involves the patient taking the initiative to coordinate and implement various therapies for pain management. Although this is actualized by the patient, all of the treatments are monitored and modulated by a team of pain care specialists including primary care physicians, mental health professionals and physical therapists.
The initial stage of chronic pain self-management is education. Patients can obtain basic instruction from their primary care provider, but more intensive education may come from chronic pain self-management courses that may last several weeks. Topics covered may include
- Methods for dealing with fatigue, isolation and frustration
- Appropriate exercise programs
- Managing medications
- Communicating with friends, family and care providers
- Monitoring mental health
- Breathing techniques
- Relaxation techniques
- Healthy diet
- Decision making about your health
- Evaluating new treatments
Chronic pain self-management is comprised of three elements:
- Medical management—this involves attending medical appointments and taking medications
- Behavioral management—adapting lifestyle
- Emotional management—processing emotions that arise due to health conditions
It should be noted that chronic pain self-management is still a developing field and there is still a great deal of uncertainty about what processes should be included. There is also a great deal of customization to meet the needs of a specific patient at any given stage of disease progression. It is therefore more difficult to set a daily routine; instead, it is more important to remain sensitive to daily health developments and tailor activities as necessary.
Kinds of Self-management Interventions
Self-management interventions (SMI) are necessary activities for empowering and guiding patients in their journey of disease management. Education is usually the cornerstone of SMIs, but these lessons may be delivered in a variety of ways including one-on-one, peer to peer, practical workshops, or support groups.
Among the most trusted SMI programs is the Stanford model which offers knowledge and skills for managing pain and related physical, emotional and social issues. This program is typically facilitated by a medical professional and community volunteer with a chronic pain condition, or two lay leaders.
Acceptance and commitment therapy is an SMI that focuses on changing behaviors that are based on fear of pain. This kind of self-management intervention cultivates desire to participate in valued activities in spite of pain. These sessions are usually moderated by a clinical psychologist or team of health care professionals from various medical disciplines.
Cognitive-behavioral therapy identifies relationships between emotions, thoughts and behaviors. As it deconstructs negative behaviors, it seeks to supplant them with more positive ones. Cognitive-behavioral therapy sessions are administered by a clinical psychologist or a cognitive-behavioral therapist.
Self-management was first defined almost four decades ago, and this type of patient actualization has since become a mainstay in the treatment of chronic illnesses like diabetes, heart disease, and, of course, chronic pain. Over the years, the efficacy of self-management for chronic pain has been debated vigorously.
It is widely accepted that self-management is influenced by social interactions. It has been shown that people with stronger familial support are more likely to maintain self-management discipline, producing better patient outcomes. Strong relationships with health care providers also play a critical role in self-management of chronic pain.
Environmental factors also play an important part in self-management. Some populations lack access to fitness facilities, while others have limited access to fresh fruit and vegetables. Some patients may live in areas with higher rates of crime that can inhibit healthy habits like outdoor exercise or nutritious food intake.
There is also some doubt about at least some self-management programs. One European study compared two randomized groups of chronic pain patients. One group participated in a six-week self-management course, while the other group participated in one hour, weekly exercise sessions for six weeks. After 12 months, the study participants were evaluated for pain symptom improvement, anxiety and depression, and quality of life. The study concluded that there was no statistical difference between the two groups.
Another meta-study that analyzed 33 smaller trials with a total of 512 participants concluded that self-management for chronic pain was susceptible to patient exhaustion and waning motivation over time. To combat this, it is necessary to implement booster sessions or peer support groups. Study researchers also concluded that shared decision making and problem solving were essential to self-management.
On the other hand, at least one study showed significant improvement following a course in self-management. A study involving 111 participants, in which 53 met one-on-one with community health workers and 58 attended group lectures, found that after 3 months of such instruction that participants could perform a sit-to-stand test significantly faster.
Although chronic pain patients should receive ongoing care and instruction from health care professionals, it is absolutely necessary that patients manage their own condition. After all, it is often their decisions that determine how their pain condition will progress; ultimately, those decisions will be made by only one individual.
Tools and health information should be made available to chronic pain patients, along with as much emotional support as possible, but the efficacy of chronic pain self-management is ultimately determined by the patient. There is no doubt ongoing research is needed to improve self-management protocols, but there should be an ever-present awareness that the patient needs to buy into the program and remain committed throughout the process.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
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