LAS VEGAS—The role of the clinician in promoting self-care among patients with chronic pain is to be an active listener, provide education, link patients with resources, set goals and solve problems, encourage engagement, and cheer both small and big successes.That’s the advice of Seddon R. Savage, MD, MS, Medical Director of the Chronic Pain and Recovery Center at Silver Hill Hospital, New Canaan, CT, who pointed out that increasingly, treating chronic pain includes integrating patient self-management strategies.
In the chronic care model, self-management support links an informed, activated patient to a prepared practice team; productive interactions can then lead to improved outcomes, added Dr. Savage, an associate professor of anesthesiology, Dartmouth College & Geisel School of Medicine at Dartmouth, Dartmouth, NH.
Mind-body approaches to pain self-management that form the basis for recovery approaches for the patient in chronic pain include cognitive behavioral therapy (CBT), meditation, self-help groups, and exercise.
CBT addresses how a patient’s thoughts, feelings, and behavior are interwoven. A patient may think, “If I move, I’ll hurt more” (thoughts), which leads to anxiety (feelings) and avoidance of movement and deconditioning (behavior). This train of thought subsequently progresses to “No one cares. No one can fix me” (thoughts), anger and fear (feelings), and muscle tension and irritability (behavior). The objectives of CBT are to move a patient from being overwhelmed with pain to feeling it is manageable; from a passive to an active role in care; and to reduce symptoms while increasing function and quality of life.
The use of varied meditation techniques can reduce anxiety, baseline sympathetic arousal, stress reactivity, muscular tension, and alter central processing.
Chronic pain support groups should be oriented to positive self-management, she said, while both aerobic and stretching exercises can tone and strengthen muscles, reducing spasms and improving alignment.
Persistent pain and addiction can both lead to sleep disturbance, substance misuse, functional disabilities, increased stresses, cognitive distortions, anxiety and depression, and secondary physical problems. That’s why in her multidimensional residential care program at Silver Hill Hospital, patients first undergo trial opioid withdrawal prior to engaging in a pain self-management program. The rationale for this approach is possible improved pain off opioids, and to determine whether a patient has opioid use disorder, which can clarify the diagnosis and eliminates issues of impaired control and adverse consequences.
In reframing chronic pain, she pointed to the Buddhist proverb, “pain is inevitable, suffering is optional.”
Dr. Savage provided attendees with a list of simple pain strategies for pain recovery that patients can post at home to help manage their chronic pain (see Table).
Table. Simple Patient Strategies for Pain Recovery
| Find something to be grateful for every day
| Move your body (within your comfort zone)
| Pace your activities
| Practice deep relaxation
| Keep your attention engaged
| Substitute a positive thought for a negative one
| Do mini checks on your wellness thru the day
| Do something nice for yourself
| Help someone else
| Use your support group