One Treatment Model for All Chronic Pain Patients

If you suffer from chronic pain or if you provide help to those who do, the information in this article will be of interest to you. It comes from the Department of Rehabilitation Medicine at the University of Washington School of Medicine in Seattle.

The basic idea is that chronic pain is managed in many different ways by different health care professionals. Psychosocial treatment recognizes there are psychological, emotional, spiritual, and social factors that affect pain perception. Techniques such as hypnosis, relaxation, meditation, and behavioral therapy are just a few examples of psychosocial interventions for chronic pain.

Each one of these approaches has its own background and theory and addresses some aspect of the psychosocial factors that affect patients in pain. Most are designed to help people learn to accept their pain and live with it in a way that increases their function (even if it doesn’t reduce their pain level or intensity).

The one drawback to so many different ways to approach chronic pain is that not all psychosocial factors will be addressed in treatment. And that means probably some patients aren’t going to be helped if the approach selected doesn’t meet their specific psychosocial needs. How do we get around this?

Well, that’s where this new proposed model comes in. It is a single, overarching plan designed to recognize, explain, and eventually measure the effects of all interventions. Such a model or organizational framework would also make it easier to study and compare different treatment effects on pain. And hopefully, it would make room for techniques that may be developed in the future.

The author reviews details of eight psychosocial treatments to pain management and then describes the proposed organizing framework to encompass them all. For example, cognitive therapy teaches people to be aware of their inner thoughts and replace the negative ones with more positive, helpful thinking. The concept is that “thoughts are not necessarily the truth, they are just thoughts” that can be changed to affect how we live and function.

Coping skills along with time and activity management (including scheduling pleasant activities) is another type of cognitive therapy. Accepting pain in a way that allows patients to live based on goals and values rather than on feelings, thoughts, and pain falls under the category of acceptance-based cognitive-behavior therapy.

A slightly different approach using hypnosis involves suggestions for ways to think about and experience pain. Many people who try hypnosis report decreased pain intensity. Studies show that combining hypnosis with cognitive therapy yields even better results. Not too different from hypnosis are the self-relaxation procedures used by some patients.

Relaxation techniques usually involve contracting and relaxing muscles, biofeedback, or listening to instructions (suggestions) to train the body to relax. Research has shown that this approach works by changing patients’ beliefs about what they can do for themselves. Reducing the stress response and experience of pain results in less perception of pain.

The proposed model recognizes five main parts of each approach including environmental factors, brain state, cognitive content, cognitive coping, and behavior. These terms may not have as much meaning to the lay reader (e.g., patient, family or support member) but they are common terms used by health care professionals helping people cope with pain.

In fact, health care providers are included (along with family and friends) under environmental factors since these folks can all have an effect on how patients think and act. Brain states refers to the relaxed, calm that results from hypnosis, meditation, and relaxation techniques and leads to better coping and tolerance for pain and suffering.

Cognitive content addresses what patients believe about their pain (especially how pain can lead to disability). How often patients think about their pain and let it control their lives falls under the cognitive content area. Cognitive coping is a way to manage mood by focusing on pleasant memories and ignoring pain. Patients are taught to set goals that lead to acceptance of pain and living life at its fullest despite pain.

And finally, behavior describes patient actions and function. The goal is participation in social activities, hobbies, work, and so on despite chronic pain. Any and all of these five factors can affect psychosocial pain treatments. Having a model that recognizes, addresses, tests and measures them may help us understand how to treat the problem of chronic pain more effectively.

The author concludes that having a broader, more encompassing psychosocial model of treatment for chronic pain will give health care providers a better overall understanding of each patient. No one will fall through the cracks because only one aspect of recovery was addressed. This proposed model with its overarching framework for organizing pain treatments takes us out of the more restrictive single-approach management of chronic pain.