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Skills, Strategies & Resources in 2010


Part of the reason for this blog is to introduce clinicians to some of the research and application of coping strategies for people with chronic pain.  While I can summarise the year’s developments in (almost) a single sentence (see below!), it’s also true that I’ve posted a lot of really interesting findings about coping over the year.  Today’s summary links to the goodies I’ve found in 2010.

Oh, my summary? There is nothing especially new under the sun in self managing pain – it’s about goals, acceptance, exercise, engaging in important activities and roles, gratitude, connecting with people…oh and mirrorbox for some lucky people for whom it works well!

Cognitive behavioural approaches to pain management

Before I post the links, a quick word to describe a CBT approach in pain management.

Many clinicians who are not psychologists, or who have primarily ‘physical’-oriented practice and training think CBT as something for health psychologists or clinical psychologists to do.  This is most emphatically not the case!

For a CBT approach to be most effective, the entire team working with a person need to adopt a CBT model as the guiding model, with individual techniques fitting into it. For people with pain, there is nothing more confusing than being given different explanations and approaches!

A CBT approach acknowledges the following:

  • That people interpret what is happening internally and externally
  • That these interpretations influence emotions and behaviours – and that relationships are reciprocal
  • That people can alter their thoughts and beliefs, and in so doing, take charge of the ways in which they respond to situations

A CBT approach assumes that:

  • People can learn to accept the chronicity of their pain
  • People can change their relationship to their pain so that instead of having an identity based on pain, symptoms, being a patient, they can become a ‘well person with pain’, or a ‘person living well with pain’
  • People can learn or re-explore skills to deal more effectively with pain

The goals of CBT are:

  • Reduce pain intensity (where this can happen)
  • Increase functional activity, including work
  • Reduce/rationalise the use of medication and healthcare resources
  • Reduce distress
  • Improve quality of life

Why use this approach?

  • Promotes reconceptualising pain as a biopsychosocial phenomenon
  • Provides for many areas of intervention
  • Effective
  • Can be conducted alongside other therapies (although combining a focus on pain reduction with pain acceptance is difficult)
  • Improves collaboration and engagement with the person who has pain
  • Promotes a common language

What comprises a CBT approach?

  • A good explanation or mental model of pain (one that includes biopsychosocial elements)
  • A collaborative approach
  • Development of active coping strategies to downregulate physiological arousal – mindfulness, diaphragmatic breathing, relaxation, hypnosis, coping statements, exercise
  • Goal setting to return to valued activities and re-engage with life
  • Problem-solving to develop alternative strategies when obstacles arise
  • Effective communication with others including intimate relationships, work, health care providers, systems
  • Linking thoughts, emotions and behaviours throughout
  • …and a few others I can’t think of right now!

(NB: the above is drawn from papers by Morley, Ecclestone & Williams, 1999; Morley & Keefe, 2007; Morley, Williams & Hussein, 2008; and lots of other assorted readings over the years!)

Can psychological management of fibromyalgia affect pain?

Developing a set-back plan

Flare-ups, breakthrough pain, or set-backs: self managing exacerbations of pain

Why bother with happiness?

Happy! Happy! Joy! Joy!

Counting your blessings

Go on, expose yourself!

Fear, anxiety and avoidance

Fear, anxiety and avoidance – reprise

Working with thoughts – habits too

What to do when feeling grumpy, low or fatigued

Essential skills for people living with pain

Graded exposure in the real world

Exercise questions

Values informing goals

Goals, outcomes, direction and values

Mindfulness and exercise

A quick (oops! long) observation on using ACT

Accepting what life throws at ya!

10 things you really oughta know about pain

Physical and organisational ergonomics

What obstacles get in the way of self managing chronic pain?

Online CALM

Links to online CBT resources

Relaxation…how, why and the evidence

Just doing it: behavioural activation

Goals – how relevant are they?

Pain and health anxiety: working with beliefs

Pain and health anxiety: working with worried people

Accepting chronic pain

Setbacks

Maintaining change

When in danger, when in doubt – deep breath in, deep breath out

Attention please! Attention management for chronic pain

That’s it for now – plenty more posts to organise though.

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