Coping with Chronic Pain: A Guide to Patient Self-management

Researchers from diverse disciplines have identified chronic pain as a critical national problem. Despite its preponderance, however, definitive diagnosis of benign chronic pain is usually elusive and direct medical intervention is often ineffective. Stressing self-management, Drs. Hanson and Gerber offer an alternative approach to biomedical management or simply "learning to live with it'' by presenting a comprehensive description of an integrated treatment approach for chronic pain sufferers.

The biopsychosocial perspective on the assessment and treatment of chronic pain that is described in this volume is based on the day-to-day operation of an effective outpatient pain clinic that evaluates clients, about 1/3 of whom are treated in an intensive 21-day patient program. The book opens with an explication of a theoretical model and a detailed description of its clinical implementation. The model's application with patients is described with emphasis on the need for a flexible theoretical approach and individualized treatment, which may include psychotherapy as an integral part of the self-management paradigm.

The biomedical and biopsychosocial models are discussed in detail with respect to how they presume pain mechanisms operate, how each views the phenomenology of the pain experience, and what are considered appropriate interventions. It is demonstrated how, rather than focusing on repairing mechanical breakdowns in the body machine, the biopsychosocial model concentrates on the individual with chronic pain. How a person appraises, reacts to, and copes with the problem and its treatment are considered crucial issues. The sociocultural context of the patient is also taken into account.

The evaluation and preparation of patients for self-management training is explicated. Topics include the reciprocal interactions among physical sensations, cognitive factors, emotional responses, overt behavior, and socioenvironmental features. The neurophysiological underpinnings of this model are briefly discussed, common self-management goals are summarized, and essential targets for change such as dysfunctional action tendencies, perceptions of uncontrollability, and self-focused attention are delineated. Complete chapters cover the critical issues of physical activity reconditioning, attentional refocusing, and a non-narcotic preventive approach for acute pain episodes. Another chapter addresses administrative, budgetary, and staff issues for operating a comprehensive pain center.

Providing a flexible and comprehensive approach that is particularly effective for chronic pain sufferers, but is also applicable to all types of illness, this volume will be of value to psychologists, physicians, nurses, social workers, and physical therapists. Ancillary health care professionals and administrators will also find much of interest.

Richard W. Hanson, PhD, U.C.L.A., U.S.C.
Kenneth E. Gerber, PhD, U.C.L.A., C.S.U.