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11 Articles in this Series
Introduction
A PAINWeek 2019 preview with EVP Debra Weiner
Comparing Marijuana and Hemp
Fibromyalgia: What’s New in Diagnosis and Pain Management
Life Hacks to Teach Patients with Chronic Pain
Managing Pain (and Function) in Osteoarthritis: Are Patients and Physicians on the Same Page?
Marijuana: How to Proceed When Controlled Substances are Involved
Menopause Comes with More than Mood Swings - It Deserves its Place Among Chronic Pain Conditions
More APPs Are Coming to the Forefront of Pain Care
Motivational Interviewing and Its Extension into Pain Management
Revisiting Documentation
Side Chat: Modern Analgesic Trials

Life Hacks to Teach Patients with Chronic Pain

with Laura Meyer-Junco, PharmD, BCPS, CPE

 

When your pain toolbox is feeling a little light, consider sharing with your patients these self-management tools put together by Laura Meyer-Junco, PharmD, BCPS, CPE, and presented at PAINWeek 2019. Dr. Meyer-Junco works as a pharmacist at a supportive oncology clinic and at a geriatric assessment clinic, both in Illinois, where she says psychotherapy resources are slim and self-care patient education is a must.

Start by adding education about pain pathways and the role of the brain in pain to every patient’s treatment plan—it’s free, safe, and effective, noted Dr. Meyer-Junco. Putting the Gate Control theory and neural plasticity, for instance, into layman’s terms for your patients may go a long way toward helping them understand that they can have some control over how they perceive and react to pain.

Many patients with a chronic pain diagnosis feel as if their identity has been stolen—who they used to be and who they are now (“a disabled chronic pain patient”) may seem like two different people. Broadening their identity, so to speak, may help to lower their pain level and disability as well as pain-related distress and activity avoidance. This process involves helping the patient to understand how emotions, thoughts, and stress may impact pain, and how they can work toward regulating those thoughts and behaviors through positive self-talk, among other approaches, to reclaim their identity. A powerful tool is the analogy of a “gate” in the spinal cord through which nerve impulses must pass to reach the brain in order for pain to be felt or perceived.  Explain that catastrophizing and negativity “hold the gate open” while self-management strategies like distraction, positive thoughts, and relaxation help to “close the gate” on pain. Essentially, said Dr. Meyer-Junco, this is watered-down CBT that clinicians may offer in small bits during regular visits.

Providing patients with simple self-management tools for chronic pain can hep to improve the pain management process. (Image: 123RF)

Offer distractions for getting through short, painful experiences. If a patient finds climbing stairs to be painful, suggest that they think about what they will do when they get to the top of the stairs, as they climb. If walking is painful, recommend that they apply a friend’s name or food item to each step. If a flare comes on, encourage them to try to focus on remembering all the words to a favorite song or on massaging one of their hands. Visualizations can be great distractions, too. A patient may visualize their pain as a symbol that they can turn and dissipate on their own (eg, for a painful joint, a patient could imagine a red knee that gradually fades until colorless). For tension and stress, a patient may imagine a tightly twisted rope slowly unraveling.

Negative self-talk and reactions are the makings of “dirty pain” in contrast to “clean pain,” which is a simple, physical sensation. Help patients see that they do have some control over their dirty pain by changing their thought patterns. Steer patients clear of “red-flag” words such as never, always, and worst-case scenario predictions.  A “thought stopper” may also be used to quickly put a stop to negative thoughts. Encourage patients to try saying a positive affirmation, such as “I can do this” or think of a smile-inducing image, such as a puppy. Coping cards with encouraging messages can also be strategically placed in the home to frame a positive state of mind. Mindfulness can be an important tool too for patients, and this involves observing the present moment (including one’s thoughts and sensations) without judging or acting on it.

Emphasize the stress-pain connection, and how chronic pain can evoke the fight-or-flight response. Teaching patients how to create a relaxation response can reset the “stress thermostat” and improve the pain experience. This reset can be achieved through diaphragmatic breathing (“belly breathing”) and use of portable relaxation audio. Sleep quality is also important to reducing pain severity. A regular sleep routine is crucial, including avoidance of food and alcohol before bed. Keeping painful knees warm may also help improve sleep. A patient can cut the toes off of an old pair of socks and wear them as sleeves on their knees.

Overall, these types of self-management tools empower patients to use mind-based interventions regardless of their setting, explained Dr. Meyer-Junco. Ideally, they will come to better understand their individual condition and how their everyday thoughts and stressors impact their own pain experience.

 

What life hacks or self-care tricks do you share with your patients? Email ppmeditorial@remedyhealthmedia.com and we will expand this list.

 

Next summary: Managing Pain (and Function) in Osteoarthritis: Are Patients and Physicians on the Same Page?
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