The Pain Education and Coping Skills Group is designed to assist individuals with chronic pain, injuries, or illness integrate behavioral pain coping skills and self-management strategies into their daily routines. The groups are led by pain psychologists and are designed to help manage mood disturbance and emotional reactions to a chronic pain condition.
Evidence based CBT ref structured cognitive-behavioral curriculum that is presented in a classroom format that includes both didactic content and structured psychotherapeutic group interaction. The classes are
1 ½- 2 hours each week for a total of 10 weeks. The groups are 10 or less participants. The group does not include any physical exercise and provides a less intensive level of care than a multidisciplinary functional restoration program. The group is designed to assist patient in accomplishing the following goals:
- To provide patients with a conceptual framework for understanding the neurophysiology of chronic pain and to understand the differences between acute and chronic pain, nociceptive and neuropathic pain and the implications for medical and behavioral management of chronic pain conditions.
- To educate patients about the role of medications in the management of chronic pain: including strategies for tracking response to medications, risks and benefits of medication use, understanding side effects, use and misuse of medications, addiction and chemical dependency issues, and strategies for reducing medication reliance through use of behavioral coping strategies.
- To educate patients about the importance of safe exercise for managing chronic pain. Patients do not engage in physical exercise in the group. They are instructed in strategies to best implement exercise recommendations provided by the treating physician and physical therapists. They are instructed in strategies for improving activities of daily living and the importance of posture and body mechanics for managing pain.
- Patients receive instruction in implementing a range a behavioral pain coping skills. Among the topics discussed are: Activity pacing, structuring daily routines, managing sleep disturbance, nutritional issues, communication issues, relaxation and meditation techniques, developing internal locus of control, diminishing fear-avoidance of activities and reducing pain-related catastrophic thinking.
- Identifying, understanding, and managing the psychological effects of chronic pain including depression, anxiety, panic attacks, frustration, anger, and impulsive behavior. Patients are instructed in strategies for implementing cognitive-behavioral techniques for managing negative thoughts and emotional states. Group members are encouraged to share their experiences with one another, and the group dynamic provides important therapeutic leverage for implementing behavioral change.
- Patients are encouraged to develop specific individualized goals for improving function in Activities of Daily Living (ADL’s), structured activities outside the home, return to work when possible, social and family interaction, hobbies, volunteer work, etc. Progress is reviewed at group meetings and in brief individual follow-up with Dr. Flores as needed.
- Topics related to understanding the workers compensation system are presented.
Among the topics discussed are how to use techniques such as progressive muscle relaxation, biofeedback, and self-hypnosis in pain management; the physiology of pain and the mind/body connection; the importance of exercise, activity pacing, and good body mechanics in the pain control; cognitive behavioral tools for coping with emotional reactions such as depression, anxiety, and anger; education about appropriate use of pain medications; issue related to addiction and dependency; emotional acceptance of chronic condition; returning to work and/or productive activities; helping spouse and family make necessary adjustments.
To assist in coping skills acquisition, participants will receive handouts and homework assignments at each session. Each participant will be asked to identify goals for improving function and activity level. Participants will be encouraged to share their experiences with the group and to provide support to other members as they work toward a healthier and happier life.
The physicians, nurses, and psychologists at Integrated Pain Management believe strongly that healthy adjustments to a chronic painful condition requires a balance interdisciplinary approach, integrating medical treatment with behavioral change, healthy lifestyles, and appropriate physical exercise. These strategies are advocated by the leading experts in the field of pain management and injury rehabilitation and have been shown in numerous research studies to offer the best chance for optimum recovery. Participants in a structured, goal-oriented group is key to success of the rehabilitation effort. For this reason, many patients at Integrated Pain Management are required by their physicians to participate in the pain education and coping skills group.
All group candidates will be required to complete a battery of screening tests prior to enrolling in the group. These tests will be used to identify appropriate group candidates. Occasionally, an individual screening interview with a psychologist will be necessary. Testing will be repeated at the end of 10 weeks to assess outcome.