The Role of Self-Management in the Treatment of Chronic Pain

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When treating chronic pain, self-management is a lot easier said than done.
When treating chronic pain, self-management is a lot easier said than done.

PALM SPRINGS, Calif. — When treating chronic pain, self-management is a lot easier said than done, even if it is the most appropriate option for boosting pain relief in a patient.

"Self-management is the medical answer," Jennifer L. Murphy, PhD, clinical director at the James A Haley VA Hospital in Tampa, Florida, said at the 32nd Annual Meeting of the American Academy of Pain Medicine (AAPM). "It is not the alternative; it is the foundation for everything else that happens."

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Before approaching the topic of self-management with a patient, there are several key areas of discussion to consider: managing medical interventions; using cognitive and behavioral strategies to manage symptoms; modifying various social roles; and addressing the emotional consequences of chronic conditions. 

"One of the key pieces of self-management has to do with the cognitive and behavioral strategies to manage symptoms," she noted in her presentation. "What we're really trying to do is to get people to respond to pain in a more effective way."

Underlying treatment goals include: increasing self-efficacy and control in a patient; collaboratively developing an action plan that includes a specific treatment while also considering implementations; and changing the way a patient responds to pain.

The "ultimate treatment goal" is to minimize the feeling of pain by making a patient feel that his or her own life is bigger than it already has been, so that the pain feels less overwhelming, she said. 

There are several challenges for patients when trying to implement self-management methods: it is difficult to embrace and incorporate self-management techniques, it is much easier to be passive than active, and it is difficult to accept that one has a chronic, incurable condition.

Additionally, patients tend to become frustrated after trying several treatment options. "I've had direct conversations with people [to remind them] that not everything has been tried," she said. 

There are also several barriers for clinicians: being aware that self-management is needed for patients to be successful; understanding that it is more difficult to emphasize self-management, mainly due to the fact that there is an increased chance of patient resistance; and being open to the idea that patient management options can be implemented in addition to standard tools. 

Tackling challenges as soon as possible may help clinicians with overcoming barriers. The concept of self-management should be introduced in primary care, and expectations should been managed from the very beginning. Educating patients about self-management is also essential. 

Collaboratively build what Dr Murphy calls a "pain action plan" with patients to outline goals from the start. This will remind patients of what they are hoping to accomplish when executing self-management approaches. 

Reference

Lorig K, Holman H. Self-management education: History, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1-7. doi:10.1207/s15324796abm2601_01.

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