Increase Patient Power In Pain Care

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Problem-solving is a key skill at work, at home and in the classroom. But problem-solving is also important for patients when managing chronic pain.

Licensed Massage Therapist Martha Menard, PhD demonstrates a form of massage

Licensed Massage Therapist Martha Menard, PhD demonstrates a form of massage

Samueli Institute’s Chronic Pain Breakthrough Collaborative teams met in January to celebrate and share what worked to increase the number of patients using non pharma and self-care therapies for chronic pain—one of the goals of the 2015 learning collaborative. Participants found that moving from a clinician-driven model of care to one that empowers patient’s self-management of chronic pain required a new outlook and skill set for both the providers and the patients.

Measures of Success in Chronic Pain Care: Empowering Patients with Self-Care Strategies

“Pain care doesn’t always involve providers,” explained Martha Menard, PhD, LMT, Executive Director of the Crocker Institute, and a faculty member for the 2015 Chronic Pain Breakthrough Collaborative.

In a recent study (published Jan 2016), Menard found a common characteristic of those living well with chronic pain was their perseverance and openness: “People were very open to trying new things and kept trying until they found what worked for them, putting together these highly individualized packages of care for themselves. They became skilled at noticing the connection between feeling stressed and making their pain worse, so they found lots of ways to incorporate self-care into their daily routine.”

According to Menard, these individuals looked for opportunities to take action to change the things in the daily life over which they did have control. These included eating a healthy diet, being more physically active, engaging in meaningful activities that gave them pleasure, and were often high users of integrative therapies like chiropractic, acupuncture, massage, and mind-body therapies like meditation or yoga.

Self-care in practice: Massage and Yoga

Pain clinics like Madigan Army Medical Center in Tacoma, Washington, employ self-care into their treatment programs to improve patient self-efficacy.

According to Diane Flynn, MD, MPH, FAAFP, the Primary Care Pain Management Advisor at Madigan Army Medical Center, a typical patient going through their three to six week pain program called IMPACT (Integrative Modalities Pain Care Team) received twice weekly acupuncture, chiropractic care, health psychology, physical therapy and occupational therapy, and once weekly foam roller massage instruction and yoga.

Foam roller massage is a type of self-massage using a dense foam roller device that can be taught to patients, and focuses on myofascial, or connective tissue pain.

Staying active is another important form of self-care, which is why the IMPACT program offers yoga.

The military and VA have recognized the value of yoga and are working to increase its availability. Outcomes studies show the potential benefits of yoga especially for chronic low back pain.

  • Learn more about Tai Chi, music therapy, and other self-care modalities in Samueli Institute’s Supplement to “Pain Medicine” summarizing the available evidence for self-care complementary modalities in chronic pain.

Developing Self-Efficacy Key to Positive Outcomes

Menard (right) and Sakallaris (left) on a panel discussion at the 2015 Chronic Pain Breakthrough Collaborative

Menard (right) and Sakallaris (left) on a panel discussion at the 2015 Chronic Pain Breakthrough Collaborative

According to Menard, one way to help patients develop a sense of self-efficacy is through social role modeling where people can learn from others’ experiences of success.

“People who may be struggling need to see models of living well with pain to know that it is possible. Seeing and hearing positive stories from other people who are living a satisfying and fulfilling life enhances their own belief that ‘Hey, maybe I could do this, too.’”

She encouraged engaging community stakeholders and local providers to collect individual success stories: “People who are living well with chronic pain are a largely untapped resource. They can serve as positive role models for people who are struggling in almost every community.”

Shared Tools to Help Patients Understand Chronic Pain

When dealing with chronic pain, it can be easy for patients to narrowly focus on the pain rather than zooming out to understand the human brain and its relationship with acute and chronic pain.

Collaborative participants shared resources, including a video explaining how to retrain the brain to heal and manage pain. The video explores the different components of pain including medical options; thoughts/ emotions; diet/lifestyle; personal history; physical activity and function.

Called “Understanding Pain”, the video was developed to provide individuals, family members, and clinicians with general strategies for managing acute and chronic pain. Based on an Australian concept for pain education, “Understanding Pain” is a product of the Department of Defense (DoD) – Veterans Health Administration (VHA) Joint Pain Education Project (JPEP).

At the final meeting of the 2015 Chronic Pain Breakthrough Collaborative, executive sponsor Bonnie Sakallaris, PhD, RN, expressed her satisfaction in the progress the teams made:

“The pain practitioners we work with share one common passion and that is for the relief of suffering and a passion to go beyond moving the needle on pain intensity scores to enable those suffering with chronic pain to manage their own health and fulfill their life’s goals. They are transforming chronic pain care through rapid cycle tests of change that lead to seamless, integrative, person-centered care.

Learn more about the process at SamueliInstitute.org/ChronicPain