Adding to the previous responses, current understanding about effective pain management of patients using the biopsychosocial approach involves:
- Educating them in non-jargon language about their pain experience, along with the difference between acute and chronic pain.
- Education about any physical cause/s of their pain and consequences of their disorder in factual, non-emotive, empowering language.
- Having treatment options explained relating to a physical cause and/or their pain.
- Being taught effective, customised self-management strategies where outcome and timeframe goals are realistic. This commonly includes posture and movement modifications to help spare particular body structures from being chronically irritated, along with fitness exercises. A gradual, rather than quick, increase in activity levels is usually necessary – pacing. It is often helpful to commence with water-based exercises before progressing to increasingly challenging land-based exercises.
- Identifying, as early as possible, any unhelpful thoughts and behaviours about their physical problem and/or chronic pain experience. Referral to a psychologist skilled in cognitive behavioural therapy (CBT) may be beneficial.
- Stopping any unhelpful treatments – particularly those in which a patient’s role is only passive and their self-management is limited.
- Educating them to expect and how to deal with progress setbacks and obstacles.
- Ensuring a supportive environment among those involved in the patient’s clinical care and life. The aim is to help minimise intentional or inadvertent progress ‘sabotage’ and maximise lasting benefits.
Patients with simpler pain problems would likely achieve good results when managed by one skilled health care practitioner. Multidisciplinary care – combined clinical assistance by practitioners with different skills – will be needed with increasing complexity of patient cases. Where progress is still not satisfactory and for intractable pain, a more comprehensive multidisciplinary approach – such as with a dedicated pain management centre – has the greatest likelihood of success.
Whichever setting where clinical care and advice is provided, the overall goal of pain management is to improve a patient’s knowledge of their condition and optimise their physical function in spite of continuing pain. As physical and psychological fitness improve as part of leading an active life, the impact of any ongoing pain is likely to gradually lessen. In some cases, the chronic pain may eventually cease, while in others, unfortunately it will persist.
Lastly, many cases of chronic pain develop following episodes of acute pain. Research studies have shown that if acute pain episodes are well managed by health care practitioners and patients, a good number of chronic pain cases can be prevented.
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