Can Coaching Patients to Cope with Complicated Pain Improve Behavior?
LAS VEGAS — The use of pain management coaching that incorporates integrative and complimentary strategies for addressing complicated pain was the topic of a PAINWeek 2016 presentation.1
According to one of the session's presenters, Becky L. Curtis, PCC, the coaching approach to pain management is based on research in neuroplasticity that demonstrated changes in nervous system structure and function in response to novel situations or changes in environment.
Attitudes toward pain have been shown to impact neuronal pathways, causing the actual experience of pain to be intensified or diminished. Patients who meet their pain with positive thoughts can induce relaxation and thereby increase functionality, whereas patients who meet their pain with negative thoughts may cause their bodies to be flooded with stress hormones, leading to muscle tension and a vicious cycle of increased pain.
In an interview with Clinical Pain Advisor, Ms Curtis explained the value of coaching for patients with chronic pain. “Coaching is the most effective modality to help patients utilize their own logic to get where they didn't know they wanted to go. Most of us who live with chronic pain have been in a ‘rescue me' mode for a long time,” she says.
“To help us get better or cope with our physical pain, our physicians refer us for therapies and surgeries and prescribe medications to make the journey a little more bearable. We mistake this help for being fixed,” she adds.
“Coaching brings the patient and medical professional together, because spending enough time with a patient to understand personal values that motivate them and what blocks their progress isn't part of the treatment plan in our medical system.”
Ms Curtis' interest in pain management coaching stems from her own experiences with chronic nerve pain following a spinal cord injury. She currently runs Take Courage Coaching, a pain management coaching practice.
In programs that typically last one year, patients with chronic pain spend one-half hour each week in a private phone call with their assigned coaches; they also participate in group sessions with other patients where ideas, challenges, and successes in pain management are shared and discussed.
“This might seem like a long time, but it's the best way for a client to learn pain management strategies, apply the tools in person, and watch themselves make progress. Where a typical patient might try a technique for a little while and get bored or lose motivation, the coached patient has accountability to a coach who recognizes how much improvement can be made,” noted Ms Curtis.
Strategies taught by Take Courage Coaching include mindfulness, self-care, cultivating gratitude, and reframing negative thoughts. The coaching practice also utilizes motivational interviewing, a nonjudgmental form of counseling that was initially devised and tested to address alcohol and drug abuse.
The goal of motivational interviewing is to increase a patient's motivation, self-efficacy, and confidence to alter behavior. In contrast to traditional directive approaches in which patients receive instructions from clinicians about what to do when pain arises, motivational interviewing increases autonomy by helping patients formulate their own personally relevant arguments for behavioral change.2
“Coaches learn the techniques of motivational interviewing specifically to draw the client from being stuck to being motivated to act, think, and behave in ways that support their values,” Ms Curtis stated.
“When clients begin to understand how basic lifestyle habits, negative thought patterns, and pain behaviors strengthen pain's hold, they are able to make choices that reduce the perception of pain,” said Ms Curtis. “The coach becomes a partner in the improvements these choices make to the person's approach to life.”
- Abney LR, Creekmur L, Curtis BL. Pain management coaching: integrative and complimentary strategies for complicated pain. Presented at: Pain Week 2016. Las Vegas, NV; September 6-10, 2016.
- Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques - facilitating behaviour change in the general practice setting. Aust Fam Physician. 2012;41(9):660-667.