of chronic pain:
Information for practitioners
If pain from an injury does not resolve within 4-6 months, a
cycle of chronic pain can develop. Once a chronic pain cycle
is established, a purely physical treatment regime rarely resolves
the problem. Chronic pain has an impact on the person, their
family and their lifestyle. Unless all these factors are addressed,
the situation frequently deteriorates and pain persists. Self-management
skills can prevent development of chronic pain, and provide skills
for self-help and self-healing in more established cases.
Suitability for the Program
Self-Management/Pain-Management programs are frequently seen as a last
resort but early referral can prevent the development of chronic pain
syndromes and the inevitable suffering for the person in pain. Many participants
in self-management programs express regret about not being referred earlier.
Part 1 of the Path
out of Pain course
may be sufficient for someone whose situation is uncomplicated, and it
enables them to take an active part in the management of their condition
soon after the injury or onset of pain. For those who have more established
pain syndromes, it is advisable to do Part 1 and Part
2. You can read more about the Path out of Pain course
Early Referral is recommended for:
1. People not responding sufficiently to physical treatment;
2. People who have become anxious and/or depressed about their pain/injury;
3. People who have not returned to work by 4-6 months;
4. People experiencing coping difficulties.
What is Pain Management?
The approach is two fold:
1. Direct pain reduction with skills
for reducing pain directly or reducing the amount the pain bothers the
2. Indirect pain reduction: To
help restore a normal lifestyle by increasing activity levels,
- resolving conflicts and grief,
- overcoming fears,
- education about pain,
- providing support and encouragement,
- learning self-management skills,
- and developing positive attitudes.
Restoring a more normal lifestyle reduces pain and/or its impact
on the person.
What is Self-Management?
The aim of self-management is to teach skills
for self-help and self-healing. It can be complementary
to other forms of treatment but the long-term goal
is to minimize the need for passive therapies. However,
one of the dangers of several practitioners being
involved, is that the person receives conflicting
advice. This is when good liaison between treating
practitioners is essential so that differences in
approaches can be identified and resolved. Self-Management
helps restore a sense of control for the person in
pain, and it is important that all the treating practitioners
support this objective.
Two keys to success with Relaxation are
daily practise, and finding the right approach for each person. A range
of techniques are taught to assist with finding the best method/s.
Many people with chronic pain are reluctant to Exercise because
it hurts. Whilst there can be contra-indications to certain exercises,
an increase in fitness, strength and mobility is essential for a return
to a normal lifestyle. Our approach is to start very gently, building
confidence with exercises designed to give relaxation through movement.
Participants are also encouraged to start getting fit with a walking
Appropriate Attitudes are fundamental
to recovery. Through talks, discussion, and videotapes participants are
introduced to a wholistic approach to management. We believe that their
condition is not just physical, nor psychological, but something which
affects them as a whole person and can only be managed effectively by
looking at the whole person: not just the injury/condition. A belief
in the possibility of recovery or improvement is fundamental. This belief
has often been shaken or lost in those who have been in pain for a long
time. Because pain is modulated by psychological factors, there is always
an opportunity for improvement.
A return to a meaningful Occupation can
be the turning point in a person's recovery. Loss of direction and purpose
in life is a recipe for persistent pain and disability. We encourage
a return to work as early as possible to prevent a chronic pain cycle
developing or, to facilitate recovery from chronic pain. Both increased
self-esteem and job satisfaction can be powerful healing forces.
Goals of the Program
- To develop a belief in recovery/improvement and their capacity
to achieve it;
- To increase self responsibility and sense of control;
- To adopt a more relaxed approach to life and learn to relax
- To reduce pain levels and/or the amount it bothers the person;
- To increase activity levels and function;
- To better understand chronic pain - how it can develop and
- To actively participate in their rehabilitation and healing.
Benefits of Groups
Whilst many people have reservations about joining groups, these reservations
usually disappear early in the course. The atmosphere is friendly and
supportive and there is no pressure to contribute to discussions: many
people learn a lot from simply listening. The group provides inspiration,
encouragement and a sense of not being alone. This can
result in a rapid shift in mood and outlook. The emphasis is on ways
to recover, not on complaints and grievances. Although grievances may
need to be aired from time to time, they are not the main focus of
the group. It is principally about education in self-management of
Some people work better on a one to one basis and it may be preferable
to do some, or all, of the work this way. A few individual sessions may
help some people overcome an obstacle to developing their self-management
program or returning to work. Others need to do longer term therapy,
addressing deeply seated patterns of behaviour and beliefs, which are
holding them back.
How You Can Support the
Familiarizing yourself with the course and its objectives will
enable you to encourage and support your patient/client during,
the course. It could be helpful to listen to the tapes, read other
on this site, look through the section on the posters, and browse
the course manual.
Participants will be encouraged to complete
a recording sheet for
their program. This assists with lifestyle change and developing
new routines. Your interest in, and support of this recording, would
When the pain increases many people panic and forget
their pain management skills. A reminder about their self-management
can help them through
a setback/flare-up and help dissolve the panic.
Obstacles to Self-Management
Obstacles to self-management and recovery can be
related to difficulties the person has with the
program but also include medico-legal issues
and "doctor shopping". You can read about obstacles to developing
self-management skills in the article about that. With doctor shopping there
is a never ending series of visits to doctors in a search for a definitive
diagnosis and a cure. It is extremely rare for people with chronic
pain to get such answers, and part of the self-management approach,
to accept this fact. Once the chronic pain cycle is established,
there is no single cause and consequently no single cure. If the
treating practitioners all support this approach, it can be a great
to make progress. Whilst some tests are necessary to rule out conditions
requiring more invasive treatment, prolonged testing and opinion
seeking can be harmful. Similarly, trying new methods of treatment
them after a few sessions when they don't work, can also create a
sense of failure and a loss of hope and faith. When the person in
involved in litigation, it can be difficult for them to focus on
self-management and recovery. Sometimes it is better to wait until
litigation is completed.
Finally, one of the greatest obstacles, is a failure to accept the
or wholistic approach to management. Some people feel their condition
is only valid if it is entirely physical.
Within the compensation system, this can be an important issue and
acceptance of the modulating effect of psychological factors appears
the claim and condition. If we help to educate our patients/clients
and others to adopt a broader perspective, it may be possible to
pressure on people in pain to prove that it is a physical problem.