Coping with Chronic Pain

The slides used in the video are reproduced below.

• • Learning to live with chronic pain
  • Psychological strategies to change the experience of pain
  • Living your life/pursuing valued goals despite the pain
  • Not being (completely) controlled by the pain

“Coping means learning to live with the pain, with chronic pain. I know in my own experience of talking to people that this is a very difficult message to hear. If you’re a person with chronic pain, to be told you have to live it…people would like their pain to be taken away. Unfortunately though, for people who have chronic pain, their pain is not likely to go away in its entirety. Probably the best you can hope for is reasonable management of your pain, sometimes. And it won’t always be effective.” 

– Prof Brian McGuire

My pain is a physical problem…why do I need to see a psychologist?

Psychology is all about future goals, not past goals. It can be boiled down to: where am I at today? And where do I want to be in the future?

If you are given a referral to a psychologist, you might think it must be because:

• • They think it’s all in my head or
  • It IS all in my head!

“How you think about pain is crucial”

A psychologist might be able to help in two ways:

• • Pain is real but is influenced by mood, thoughts, beliefs, reactions of others, social and cultural factors (in other words, it’s not just the actual tissue damage that determines your pain)
  • Pain is a negative and often traumatic experience – it affects mood, stress, anxiety, activity (fear of movement), social roles.

“There’s a lot more involved in pain management than reducing the physical sensation of pain.”

– Prof Brian McGuire

The range of areas that pain management can have an impact upon are:  

• • Education and understanding
  • Dealing with anger, frustration, resentment, emotional distress, sense of injustice
  • Physical (in)activity
  • Unhelpful thoughts and beliefs
  • Coming to terms with repeated treatment failures
  • Medication (mis)use
  • Changes in family, lifestyle and roles (loss)
  • Depression
  • Anxiety and stress
  • Sleep
  • Preoccupation with pain, fear of pain, pain identity, excessive disability
  • Pain reduction (e.g. attentional control)

Accept

• • Acceptance may be a difficult word to hear. 
  • It’s not about giving up hope, but finding the balance between having hope, accepting that you have this chronic condition, and getting on with your life despite the pain 

Adapt 

• • Learning to adapt to your environment

Adjust

• • Learning how to make a healthy, psychological adjustment

The ultimate goals of pain management are better coping and improved quality of life despite the pain!

Multidisciplinary Pain Management: Approach with the best evidence 

“Recommended Guidelines For Pain Management Programmes For Adults”

– The British Pain Society, 2007

“Pain management programmes (PMPs), based on cognitive behavioural principles, are the treatment of choice for people with persistent pain.”

Medical specialist, psychologist, physiotherapist, nurse, OT.

Pain management programmes consist of education on:

• • pain physiology
  • pain psychology
  • healthy function and self-management of pain problems
  • guided practice on goal setting
  • exercise and activity pacing
  • identifying and changing unhelpful beliefs
  • Relaxation
  • Communication skills
  • Changing habits which contributes to disability

 The need for a national strategy for chronic pain management in Ireland

“Facilities for treating patients with chronic pain in Ireland are lacking. There are currently no multidisciplinary pain clinics or pain clinics that meet the IASP recommended guidelines for the management of chronic pain patients. Despite the debate on the need for dedicated treatment facilities and appropriately trained multidisciplinary staff opening at government level in 2000, no further action has been taken. The protracted waiting time for patients to be assessed for a multidisciplinary pain clinic is beyond the acceptable time (12 weeks) as defined by the government’s Health Strategy document.”

– Fullen et al, Irish Journal of Medical Science, Volume 175, Number 2

So what do we need to do?

• • More pain management specialists
  • More allied health professionals trained in pain management
  • More pain clinics
  • Properly resourced multidisciplinary pain management programmes
  • Centres of Excellence for clinical services and clinical research
  • A National Strategy for addressing chronic pain

There is a National Strategy for Cancer, a National Strategy for Obesity. But there is no National Strategy for Pain.