Management of Complicated Pain With Coaching

The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of Clinical Pain Advisor‘s conference coverage.

LAS VEGAS — During a presentation they gave at PAINWeek 2017, held September 5 to 9, Lesa R. Abney, BSN, from Vanderbilt University Medical Center, Nashville, Tennessee, and Becky L. Curtis, PCC, presented effective coaching strategies they use on their clients with complicated pain.¹

Abney presented the case of a 58-year-old man who had developed complicated pain after a motorcycle accident for which he had undergone multiple surgeries. After his accident, this patient had developed very unhealthy habits, including a bad diet and drinking. As a consequence, he started feeling worthless and limited, with a sense of reduced freedom and increased dependence, and low self-efficacy and self-confidence: depression started setting in. In addition, he started losing hope, anticipating pain, and having negative automatic thoughts.

The pain management coaching for complicated pain Abney practices at Vanderbilt University consists of a 1-year program. This program length is necessary, as detrimental habits are engrained for lots of those patients. During coaching sessions, she talks about acceptance, monthly goals are set, and progress is regularly assessed. Through this program, she seeks to build self-confidence in patients. The program includes 30-minute-long individual sessions each week, as well as group coaching with teleclasses during which educational and motivational material is provided.

Different brain areas are involved in pain processing and pain anticipation. “What we focus on, we empower and enlarge,” said Curtis, herself a patient with complicated pain. In Abney’s 58-year-old patient, all thoughts were negative before he joined her program: his pain awareness was leading to negative thoughts, thus releasing stress hormones, increasing muscle tension and pain. Through her coaching, she taught him to, instead, turn his awareness of pain into positive thoughts, so as to reach acceptance and relaxation and achieve increased movement and functionality.

Abney provided tools to start a similar coaching program: patients need to be made aware of their automatic thoughts, which can affect their pain; spirituality may also help them cope; and they need to be given or choose goals, no matter how small (eg, “I will work for 10 min and rest for 5 min”); finally, they need to figure out lifestyle changes that might benefit them.

Lots of those behavior changes are needed, and most of them require some intentionality, said Curtis. “It is an attitude, and takes some work,” she added. The best way to alter one’s feelings is to ask positive questions, such as: “What am I thankful for?” or “What am I excited about?” In this way, the limbic system gets flooded with positive anticipation that induces a positive emotional state, she said.

The notion of brain plasticity is fundamental to the development of pain management strategies, emphasized Curtis. Complicated pain management coaching puts the focus on positive attitudes, including self-compassion, which are often neglected by patients with complicated pain.

Group coaching allows patients who may be isolated if living in rural areas to lessen that feeling. During those sessions, Abney often witnesses patients encouraging and supporting one another, sharing their stories. A lot of topics are covered during group sessions, from exercise and pacing activities to smoking cessation. “These sessions are about finding solutions,” she emphasized. “They provide a great learning environment.” She cited a particular group she coached in which most patients were able to get off their opioid medications.

Read more of Clinical Pain Advisor‘s coverage of PAINWeek 2017 by visiting the conference page.

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Reference

1. Abney LR, Curtis BL. Pain management coaching: Integrative and complementary strategies for complicated pain. Presented at PAINWeek 2017; September 5-9, 2017; Las Vegas, NV.