At the 2018 American Academy of Pain Medicine Annual Meeting, James Atchison, DO, from Shirley Ryan AbilityLab discussed working with patients to build a self-treatment plan. Patients need to be educated on both the physical and mental (cognitive) elements of pain.
Physical areas of focus for a treatment program:
- Body mechanics/positioning.
- Exercise including strengthening, muscle balance and an aerobic component.
Cognitive areas of focus for a treatment program:
- Relaxation including breathing.
- Graded Motor Imagery including left-right discrimination, localization and mirror.
Categories of treatment – Medical:
- Is work-up complete?
- Are there known contraindications/restrictions?
- What are self-imposed limitations/restrictions?
- Will medications or procedures help to get started?
What Can We Change?
- Physical function.
- Ability to cope with pain.
- Ability to manage flares.
- Medication effectiveness.
Key Points for Success
- Breaking old habits and developing new ones.
- Sessions must be active both physically and mentally.
- The brain must be working and engaged.
Compliance is key as the patient must actively participate, understand and accept the pain and self management techniques, and incorporate and utilize the techniques learned outside the scheduled program. That ability and willingness to self-treat ultimately determines if the program is successful.
You must find the appropriate level to start in the program. If you start at too high an activity level pain will be increased, the patient will fatigue, and then fear kicks in.
It is also important to determine if the patient is willing to change their thinking and habits. They must overcome “all or nothing” mentality.
Knowing the patient’s goals are extremely important. What tasks are important to them that you can focus on helping them achieve. Find what motivates them.
A Good Program:
- Has an active approach.
- Provides the environment of ability not disability.
- Understands that medications can play a role especially in terms helping with side effects such as sleep disorder or anxiety.