Today’s post completes the results from my coping strategies survey by identifying how important the skills are in the respondent’s view. Remember these are all health professionals who work in pain management, and the questionnaire was completed online and confidentially.
What you can see there is that the most important skill, as identified in this survey, is ‘Working with realistic thoughts’. What’s surprising about this is that respondents were not ALL psychologists! In some ways, this is probably one of the most important components in pain management because it encompasses all the cognitive elements involved in reconceptualising chronic pain from something that represents alarm and harm, into something that is simply ‘noise in the system’.
Self regulation was the next most important skill. This is the process of setting goals, and organising the ‘self’ to achieve them by modulating arousal level, establishing steps for moving forward, and working with feedback to persist with progress despite set backs. It’s interesting that self regulation is not mentioned at all in the documents I recently reviewed for ‘Intensive pain management programmes’ with a major purchaser of services in New Zealand. Self regulation is certainly something that is included in almost all the pain management programmes delivered at Burwood Pain Management Centre, although it may not be called that in so many words. It can masquerade as ‘goal setting’, ‘activity scheduling’ and ‘relaxation’ – all of which are components of the larger dimension of self regulation.
I was curious to see that task simplification scored as highly as it did. I think I mentioned that I rarely think of helping people develop this as a skill – as one respondent said, and I agree, it ‘infers avoidance’. I can see the value of task simplification in health conditions that have a gradually reducing level of energy such as multiple sclerosis, but chronic pain doesn’t need to have this prognosis. Task simplification suggests that simply by reducing activity level (or the strength or energy required to carry out a task), pain will reduce. Sadly, this isn’t so except in the short term, which is why resting is not recommended. Regulating activity level to ensure a consistent amount of activity is carried out through a day (rather than booming or busting, or being completely inactive – or even overactive) seems to be a more helpful approach, although it’s not easy to do.
Finally, although exercising brought all sorts of comments out of the woodwork when I asked about it earlier in the survey, it wasn’t thought to be the most important skill. At least nobody thought it was least important, but the majority thought it was either important or very important, with 3.8% of respondents indicating it was ‘critical’ (that must have been a physiotherapist!). Personally, I think activity can be substituted for exercise, provided that the activity can be carried out regularly, raises the heart rate, encourages full range of movement, and is fun!
I enjoyed conducting this survey. Even though the response rate was lower than I had hoped, it does provide you, reading this blog, some indication of what other professionals who also read this blog, think about coping strategies. I’ll be carrying out another survey soon, looking at goals and goal-setting – another area of pain management that is assumed to be great and helpful, but the process isn’t well-defined and deserves more investigation specific to pain management.