Originally published on MPR - Monthly Prescribing Reference.
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Dr. Keefe began by explaining that underlying disease activity does not necessarily correlate with pain that a patient experiences. For instance, when looking at similar x-ray images of patients with osteoarthritis (OA), differences were found in the varying degrees that patients classified their pain, indicating that symptoms may not directly correlate with x-ray evidence of OA.
So what is going on to explain this difference? " What seems to be especially important in comprehending persons with disease-related pain is catastrophizing, or the tendency to focus on and exaggerate the threat value of painful stimuli and negatively evaluate one's own ability to deal with the pain, " explained Dr. Keefe. "We already know that pain catastrophizing is key to understanding chronic pain." In fact, early studies in patients with chronic non-malignant pain show that these patients exhibit more pain, take more pain medications, and experience more physical disability. In one example of a study of 101 OA patients undergoing knee replacement surgery, patients who were identified pre-surgically as "pain catastrophizers" were 4.5 times more likely to show a poor outcome. Please see corresponding PowerPoint slides for more information.
So what can be done to help patients improve their coping and appraisal skills? "Basic elements of coping skills training protocols include helping patients reconceptualize pain and pain control, systemic training in coping skills–such as relaxation, activity pacing, cognitive restructuring, distraction, and imagery–and behavioral rehearsal and guided practice," Dr. Keefe explained. Additional findings of a pilot study involving relationship enhancement for breast cancer patients and their partners showed patient improvements in symptoms (pain, fatigue, and nausea), functional well-being, self image, body acceptance, and relationship functioning, while caregiver enhancements included psychological distress reduction and posttraumatic growth.
Studies in children at the University of Washington using the virtual reality program "Snow World" showed a 40% to 50% reduction in pain for patients receiving the intervention. Other programs such as one Magdalena R. Naylor, MD, PhD, from the University of Vermont College of Medicine in Burlington, Vt. and colleagues are exploring show that a telephone feedback system helps patients with chronic pain reduce their symptoms and improve their coping skills, while discouraging them from relapsing into counterproductive behaviors. Important to note is that more and more, many of these new programs are being integrated into clinical practice.
In summary Dr. Keefe concluded that, "Developing and refining interventions to enhance pain coping can lead to major advances, including pain prevention, an improvement in quality of life, and reducing the suffering of many individuals having disease-related pain."