To move forward in medicine, perhaps the best approach would be to take a step back and rethink what the medical community considers to be standard care. Understanding the reasoning behind why things are the way they are enables clinicians to keep what works and fix what doesn’t. Applying this process to pain management encourages medical specialists to meet their patients’ myriad clinical and emotional needs.
Becky Curtis, PCC, believes pain-management paradigms need to be reexamined to effectively manage and treat pain in patients. As a survivor of a serious rollover motor vehicle accident in a remote Montana location, she recognized the need to advocate for those suffering with chronic pain. The pain management coach points out that there are several ways a physician can build an environment where both the clinician and patient become an integral part of the pain-management process: developing new language tools to empower patients; acquiring methods to reduce stress in working with patients; and learning to establish restorative partnerships with patients.
“I know many physicians who are building restorative relationships with patients. But those who do take fewer patients, and take more time with them,” she said. “Those who aren't may have time constraints that make it difficult to work this closely with a patient.”
Understanding what a patient with chronic pain is experiencing can build upon those foundational elements. Individuals with chronic pain often report a sense of feeling defeated. They may lack a support system and often don’t have appropriate coping skills for managing the effects of their pain. They may experience depression, low self-esteem, and low levels of confidence. Negative-thinking patterns and fear-avoidance behavior can also contribute to pain syndromes.
These aspects of a life in pain can impede an individual’s ability to see beyond his or her personal situation. In addition, the stigma associated with chronic pain negatively affects the way patients with chronic pain see themselves. Ms. Curtis advises healthcare practitioners to encourage their patients to engage in exercise and to increase their activity so that they can stay functional by learning to cope with their conditions.
Patients often ask, “What is wrong with me? Can you fix it? Will it work? What if it doesn’t work? Why did this happen to me?” When patient concerns and fears are recognized and addressed at the outset, physicians will be better equipped to engage patients in their care.
“From my perspective as a patient, we have a ‘taking the car to a mechanic’ paradigm instead of a biopsychosocial paradigm,” Ms. Curtis said. “The patient basically thinks, ‘I'll just sit here while you fix it and then, when you're done, I will drive away happily cured.’ And yet we know from the latest research in pain management, that it takes an actively engaged patient to manage his or her own pain.”
She continued: “This problem begins with the patient, yet it is easy for a provider to fall into the trap of trying to meet the patient's expectations, thereby embracing this faulty paradigm themselves.”
Empowering patients can help them alleviate pain on their own. During her presentation, Ms. Curtis made note of several chronic pain treatments and stopped short of endorsing them as methods to relieve patients of their symptoms. She suggests a “focused-attention” approach that can be used to “positively reprogram brain pathways.”
As Ms. Curtis described, the brain learns how to manage pain on its own. Normally, 5% of brain cells are dedicated to processing pain. In the setting of chronic pain, however, the brain uses 15% to 25% of its cells. With sufficient repetition, brain pathways strengthen, resulting in anatomical changes.1
Educating patients on chronic pain can help them cope with their conditions, she said. Managing pain is a team effort between physician and patient. Once a patient accepts responsibility for managing pain symptoms, the healing process can begin.
“The new paradigm takes patients out of the mechanic's waiting room and puts them in the driver's seat,” she said. “It's a paradigm that is more organic than mechanic. What is needed is a new tool in the provider's tool box: referral to a pain management coach.”
“Pain management coaching is a ‘new paradigm’ discipline specifically designed to educate, motivate, and empower people with chronic pain to take an active role in their own pain management,” Curtis said. “A pain management coach works collaboratively with clients, handing them the tools they need to be active managers of their own pain experience. A pain management coach educates them on the latest evidence-based modalities, motivating and empowering them to throw pain back in the trunk where it belongs, while reclaiming the driver's seat.”
1. Moskowitz MH, Golden M. Neuroplastic transformation: transforming the brain in pain. Available at: http://www.neuroplastix.com/styled-6/workbook.html. Accessed August 13, 2015.