Behavioral Medicine and Coaching Interventions in Chronic Pain

Significant understanding of the behavioral neuroscience of pain has developed over the past 20 years and has helped evolve dynamic evaluation and treatment models that work successfully in the workers’ compensation system. These models show positive results, not only in advanced claims with chronic pain and opioid dependence/addiction, but in early proactive claims intervention to create pathways to better outcomes. This was the subject of a presentation at the 2015 SIIA Workers’ Compensation Executive Forum.

The speakers were:

Michael Coupland, CPsych, RPsych, CRC
CEO, Network Medical Director
Integrated Medical Case Solutions (IMCS Group)

Becky Curtis
Pain Management Coach
Founder, Take Courage Coaching

Pain is one of the leading causes of disability and impairment in workers’ compensation. Pain is a very subjective thing that impacts every patient differently. Studies have shown that there are a variety of issues that can impact patients perceptions of pain. These include:

• Catastrophic thinking
• Fear avoidance behavior ( guarding)
• Perceived injustice
• History of childhood abuse
• Depression, anxiety or personality disorders
• Work attachment
• Lifestyle issues such as exercise, smoking, alcohol and drug use, obesity, diet

The purpose of cognitive behavioral therapy is to change the way patients react to pain situations so that they can achieve better medical outcomes. One way of doing this is gate control therapy. This involves using physical activity as a form of pain control because the body’s central nervous system gives motor functions a priority over pain sensations, so engaging in physical activity will actually distract your body’s perception of pain. There are a number of cognitive behavioral techniques that have been developed that focus on distracting a person from thinking about their pain and helping them develop better coping skills.

Excessive use of opioid medications can actually inhibit pain control because they suppress bodily functions that assist in pain coping skills. Also, after long-term use, the body will exhibit symptoms of withdrawal as the drug diminishes in their body, however, patients will attribute these withdrawal symptoms to pain.

One of the obstacles to cognitive behavioral therapy has been the adjuster’s hesitance to allow any type of “psychological” treatment on the claim.  One solution to this is developing CPT codes that allow for the cognitive therapy without providing the diagnosis of a psychological condition.