Here: a comprehensive strategy that can reduce pain, restore function, and improve quality of life.
1. Kroska EB. A meta-analysis of fear-avoidance and pain intensity: the paradox of chronic pain. Scand J Pain. 2016;13:43-58.2. Shim EJ, Hahm BJ, Go DJ, et al. Modeling quality of life in patients with rheumatic diseases: the role of pain catastrophizing, fear-avoidance beliefs, physical disability, and depression. Disabil Rehabil. 2017;14:1-8.3. Pergolizzi JV Jr, Lequang JA, Taylor R Jr, et al. The role of cannabinoids in pain control: the good, the bad, and the ugly. Minerva Anestesiol. 2018 Jan 16. doi: 10.23736/S0375-9393.18.12287-5.4. Romero-Sandoval EA, Kolano AL, Alvarado-VÃ¡zquez PA. Cannabis and cannabinoids for chronic pain. Curr Rheumatol Rep. 2017;19:67.5. Thong ISK, Tan G, Jensen MP. The buffering role of positive affect on the association between pain intensity and pain related outcomes. Scand J Pain. 2017;14:91-97.6. Wojcikowski K, Vigar VJ, Oliver CJ. New concepts of chronic pain and the potential role of complementary therapies. Altern Ther Health Med. 2018 Mar 10. pii: AT5525. [Epub ahead of print]
The management of chronic pain requires a comprehensive approach to finding incremental solutions that allow for a better quality of life. (©Lightspring/Shutterstock.com)
Chronic pain can occur for any number of reasons-and sometimes for no reason at all. Patients who hope for a cure are often disappointed to learn that the cause of their pain may not even be diagnosed.
Patients with chronic pain syndromes (eg, rheumatoid arthritis, osteoarthritis, migraine) often develop a sense of hopelessness that may extend into everyday life, which makes treatment difficult. (©PrinceofLove/Shutterstock.com)
Fear and avoidance of pain and catastrophizing are among the most damaging behavioral responses because they interfere with treatment and exert a deleterious influence on daily quality of life, as patients focus attention on the pain.1,2 Avoidance is a negative predictor of pain outcomes and, together with fear responses, may actually increase both the perceived experience and the pain intensity itself.1,2 The result is often greater avoidance, which produces an escalating pain cycle. Catastrophizing has been studied particularly in rheumatic diseases, where negative affect toward pain sets poor expectations and perceptions that fuel hopelessness, depression, and the continuing cycle of pain.2
A comprehensive strategy that targets multiple contributing factors to chronic pain is important to effective management-and requires a multidisciplinary team.2 The PCP guides treatment decisions and puts together a plan that involves drug therapies, as well as interventions that target the psychological and physiological aspects of the patient's chronic pain patterns. In addition, the PCP educates patients about treatment options and monitors progress.
A wide range of analgesic agents are used for chronic pain, including opioids, which carry a high risk of dependence. Antidepressants may be especially beneficial because they also target associated depression. Nerve block therapies and Botox injections can help with specific indications. Cortisone injections are used for certain types of muscle and joint pain, although they do not provide long-term benefits and have to be repeated. Cannabinoids have shown some benefits for chronic pain; however, the adverse effects of cannabis include memory loss and possible cognitive impairment.3,4
Psychological therapies are extremely important in chronic pain; they are aimed primarily at reducing symptoms of catastrophizing, avoidance, and fear of pain. Behavioral therapies such as CBT are generally effective and may be supported by the addition of hypnosis and mindful meditation. Recent research in chronic rheumatic pain now points to adoption of "positive psychology" approaches designed to retrain negative affects toward pain and refocus on positive outcomes.2,5
Approaches that promote a physical relaxation response help reduce the impact of chronic pain and improve participation in daily activities. Encourage patients to investigate alternative therapies, exercise, and relaxation approaches to reducing the body's physiological response to pain. In particular, muscle relaxation activities such as yoga, meditation, tai chi, and massage therapy can improve physiological well-being.
Chronic pain can often reach levels where it takes attention away from activities of daily living. Ruminating on pain leads to depression and increases the perception of pain-which can, in turn, intensify the experience. Psychological techniques such as distraction and guided imaging help turn attention away from pain signals, while dissociation teaches the brain to lessen response to the signals.