Supporting patients’ adherence in pain self-management: how to proceed? – Editorial

Adherence in pain treatment in clinical practice and research is critical. Further, an important component in managing chronic pain, but also in other chronic conditions, is supporting patients to develop and engage in new behaviours, e.g. using self-management strategies that need to be sustained over time. However, how to effectively support and increase adherence to treatment representing a new behaviour is not clear.

The adherence concept is considered as a development of the compliance concept. Compliance from a patient’s point of view is not an autonomous decision-making process. It is more of following orders from physiotherapist or other health care staff. Adherence however is a patient-centered communication of recommendation where the patient independently decides against or for a mutual agreement and advice.

For the past few decades there has been little attention on strategies to increase adherence to achieve sustained behavioural change. The past research has focussed on the problems of non-adherence rather than studying solutions of supporting adherence. There is a great need of advancing in our understanding of how to handle the key barriers to adherence and how to coach changes in patient’s or client’s adherence behaviour in pain self-management. Also, the App and Web-based strategies to promote adherence in treatments for chronic pain and other chronic conditions do need to be studied. Significant levels of adherence to physical activity and exercise programs have shown high correlations with positive outcomes in pain management. However, research on effective strategies for supporting adherence is lacking. Very likely, patients’ and clients’ beliefs, cognitions, and emotions play an important role in finding successful and supportive behaviour change strategies for adherence.

In a scoping review, it was shown that for supporting adherence, capability-related strategies such as education of the patient, supervision, mastery of and grading of activities and exercise aiming to increase self-efficacy were important. Further, motivation increasing strategies such as identifying readiness for change, self-monitoring of behaviour and goal setting seem to have positive impact on adherence. Additionally, strategies that could be related to opportunity for change were having booster sessions, getting feedback from therapist or significant others as well as social support facilitated adherence to activities and exercise [1].

Understanding and applying strategies for increasing adherence to the pain self-management regimes in research and clinical work is essential to improve long-term pain outcomes. It is time to address these interventional behaviour change-related challenges in pain self-management within clinical practice and research.