The key ingredients for successful self-management of chronic pain
The outlook for the one in five New Zealanders with persistent or chronic pain has the potential to be more positive according to an extensive study review by researchers from the School of Physiotherapy, University of Otago, Wellington (UOW) and Pain Management Service, Capital Coast District Health Board.
The review – published in a recent issue of Physical Therapy – covered 33 studies that explored the perceptions of 512 people with chronic pain, after taking part in some form of pain self-management intervention.
"Chronic pain is defined as pain that persists for longer than three months. 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," says lead researcher Dr. Hemakumar Devan, from the School of Physiotherapy, Wellington.
"The normal response to acute pain is to avoid activities that increase the pain and spend time resting and recovering, however, prolonged avoidance can make the chronic pain patient's condition worse. For pain conditions where there is not currently a curative treatment, self-management strategies can help people to live well with pain and have a better quality of life", says Ms Dagmar Hempel and Ms Barbara Saipe, Pain Management Service clinicians from Capital and Coast District Health Board (CCDHB).
"In the review, we honed in on what enabled and what stood in the way of the chronic pain participants effectively incorporating self-management strategies into their everyday life following the intervention," says Dr. Devan.
Several key enabling factors stood out.
"Being able to distinguish their 'self' – body, thoughts, and feelings – from the pain was crucial," Dr. Devan says.
"Understanding how pain works and the value of the strategies – such as pacing or increasing daily activities, relaxation, and meditation – reinforced the participants' ability to self-reflect and accept how they might live well with chronic pain. It also fostered their ability to continue to use the strategies they had learnt."
"Having health practitioners who listened, validated the person and acknowledged what they're going through went a long way to engaging those with chronic pain in the self-management process."
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," says Dr. Devan, "and this in turn affected their adherence to practising self-management strategies."
Health professionals who did not appear to believe their symptoms nor recognise the ongoing efforts to manage pain were further significant barriers. Unsupportive family, friends and a lack of validation of their symptoms at work also affected their ability and confidence to manage pain on a daily basis.
The last decade has seen a huge shift in the definition and management of chronic pain, with it now recognised as a long term condition in its own right, rather than just a symptom, causing neuroplastic changes in the brain and spinal cord, often responding much better to self-management strategies (such as pain education, exercise, relaxation, distraction and meditation), than pharmaceuticals.
"Chronic pain is an invisible condition that needs more visibility," says 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."
This review complements other work on chronic pain and self-management interventions being carried out by Dr. Devan and colleagues at the University of Otago, Wellington in collaboration with others.
More information: Hemakumar Devan et al. 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). DOI: 10.1093/ptj/pzy029