A review by researchers from the University of Otago, School of Physiotherapy, Wellington and the Capital & Coast DHB’s Pain Management Service has found that patients can self-manage their chronic pain better if they feel listened to and acknowledged by clinicians, while feeling disbelieved can hinder them.
The review, published in a recent issue of Physical Therapy, analysed 33 studies involving more than 500 people with chronic pain who had taken part in some form of self-pain management to see what helped or didn’t help them deal with their pain.
The attitudes of clinicians – as well as family friends and work colleagues – was one area found by the researchers to be influential.
Chronic pain is defined as pain that persists for longer than three months. In the past decade there has been a big shift in how chronic pain is regarded and managed, including it now being recognised as a long-term condition in its own right and not just a symptom.
Chronic pain can result in neuroplastic changes in the brain and spinal cord, which may often respond better to self-management strategies (such as pain education, exercise, relaxation, distraction and meditation), than to medication.
Lead researcher Dr Hemakumar Devan from the School of Physiotherapy said that the motivation to self-manage chronic pain and associated symptoms, such as anxiety and depression, can be very challenging in everyday life and particularly during flare ups.
Dagmar Hempel and Barbara Saipe, CCDHB Pain Management Service clinicians, said self-management strategies can help people have a better quality of life and help them live well with pain conditions for which there is currently not a treatment that can cure it.
Dr Devan said the review found a number of factors that helped people successfully engage with self-management approaches, including having health practitioners who “listened, validated the person and acknowledged what they’re going through”.
“Being able to distinguish their ‘self’ – body, thoughts and feelings – from the pain was crucial,” he said.
Also understanding how pain worked and the value of the strategies – such as pacing or increasing daily activities, relaxation and meditation – helped them self-reflect and accept how they might live well with chronic pain.
Supportive relationships with family, friends and work colleagues work environment increased their confidence to self-manage pain and associated symptoms on a daily basis.
“On the flip side, a lack of understanding of chronic pain mechanisms and/or beliefs that chronic pain can be completely fixed or cured impeded their ability to accept their new ‘self’ with pain, and this in turn affected their adherence to practising self-management strategies,” said Dr Devan.
Health professionals who didn’t appear to believe their symptoms or recognise the patient’s ongoing efforts to manage pain were also significant barriers. Unsupportive family, friends and a lack of validation of their symptoms at work also affected people’s ability and confidence to manage pain on a daily basis.
“Chronic pain is an invisible condition that needs more visibility,” said Dr Devan.
“It disproportionately affects Māori, older adults and people living in areas of high deprivation, according to findings from the recent National Health Survey.”
“This review gives weight to the ideas many of us working in the pain sector are aware of – it’s time that all clinicians and the wider community were aware of the role they can play in helping enable those with chronic pain and their whānau live fulfilling lives.”
The team’s review concluded that sustained effort to self-manage chronic pain could be “exhausting” and motivation could wane over time following intervention. So providing intermittent support in the form of booster sessions and peer support groups may be important.
Also “person-centered care via shared decision-making and guided problem-solving is essential to facilitating ongoing self-management,” said Dr Devan.
Source: Health Central August 28, 2018
Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis Physical Therapy 2018 May 1;98 (5):381–397.
Find out more about Dr Hemakumar Devan