Self-Management Interventions for Chronic Pain

Figures & data

Table 1. Overview of common self-management interventions.

Intervention	Common topics	Typical mode and length	Ref.
Stanford Model (includes Chronic Pain Self-Management Program, Arthritis Self-Management Program and Chronic Angina Self-Management Program)	Self-management principles/responsibilities Goal setting and action plans Pain management tools (e.g., use of medications and multiple cognitive strategies) Problem solving Physical activity and exercise Healthy eating Dealing with difficult emotions and depression Fatigue and sleep Working with your healthcare provider	Group sessions: ▪ 6 weeks with 2 h of group sessions per week (total: 12 h) Online: ▪ 6 weeks with 1–2 h online per week to cover all 25 sessions (total: 6–12 h) Workbook provided for group and online sessions	[201]
Acceptance and commitment therapy	Principles of the pain–avoidance–suffering cycle Identifying values/valued activities, and gradually increasing exposure to value-directed behavior (instead of pain-directed behavior) Cognitive defusion (identifying and observing negative thoughts without acting on them, and distancing oneself from them) Mindfulness Accepting and being willing to engage with pain Committing to action and identifying obstacles to desired action Planning for future action and obstacles	Group sessions: ▪ 3–4 weeks of 6.5 h per day for 5 days of each week ▪ 8 weeks of 1.5 h sessions per week Workbook with telephone support ± one individual session: ▪ 6 weeks of scheduled workbook exercises with one telephone call per week	[15]
Modified cognitive–behavioral therapy^†	Cognitive restructuring (e.g., identifying and evaluating catastrophic thinking and constructing realistic alternatives) Identifying and restructuring pain avoidance beliefs and behaviors Behavioral activation (e.g., pacing and activity scheduling) Understanding biopsychosocial influences of pain goal setting Lifestyle changes (e.g., exercise) Self-regulatory skills (e.g., progressive muscle relaxation and breathing exercises) Pain management skills (e.g., attention diversion and stress-coping skills) Relapse prevention strategies	Group sessions: ▪ 5–12 weeks with 1.5–2 h sessions per week Individual sessions: ▪ 6–25 weeks with two to 25 sessions Online: ▪ 4–8 weeks with one or more modules per week	[202]

† Reflects cognitive–behavioural therapy as it has been modified in the current literature to include elements of self-management and self-efficacy.

Table 2. Factors predicting or associated with positive outcomes of self-management intervention.

Factors	Predictors/correlates/mediators/moderators of positive outcomes
Demographic	Non-Caucasian ethnicity [111] Older age [112]
Health status	Pain intensity [113,114] Fewer comorbid conditions [112] Physical activity [115]
Mental health	High baseline levels of pain-related anxiety [111] Catastrophizing [113] Optimism [112]
Pain and management beliefs	High self-efficacy [96,108,115–117] Sense of internal control over pain [96] High perceived importance of self-management behavior [117,118] High acceptance of chronic pain and perceived ability to manage it [113,119] Pain beliefs [120] Stage of change/readiness to change (contemplation, action or maintenance stage as per the Pain Stages of Change Questionnaire) [106,117,118,121]
Current self-management skills	Use of self-management strategies prior to intervention [114] High level of mastery in skills related to care of condition [112]
Healthcare provider‘s actions	Giving information on the effectiveness of self-management strategies and illness, and clarifying doubts and questions during clinical encounters [114] Receiving loss-based messaging of self-management behaviors (e.g., “if you don‘t perform self-management behaviour X you may experience the following negative consequences…”) [108] High satisfaction with information provided by primary care physician [96]

Stanford Medicine. Chronic Pain Self-Management Program. http://patienteducation.stanford.edu/programs/cpsmp.html

 Google Scholar

Hayes SC , LuomaJB, BondFW, MasudaA, LillisJ. Acceptance and commitment therapy: model, processes and outcomes. Behav. Res. Ther.44(1) , 1–25 (2006).

 PubMed Web of Science ®Google Scholar

Cognitive behavioural therapy core information document. www.health.gov.bc.ca/library/publications/year/2007/MHA_CognitiveBehavioural.Therapy.pdf

 Google Scholar

Cucciare M , SorrellJ, TraftonJ. Predicting response to cognitive–behavioral therapy in a sample of HIV-positive patients with chronic pain. J. Behav. Med.32(4) , 340–348 (2009).

 PubMed Web of Science ®Google Scholar

Kurtz ME , KurtzJC, GivenCW, GivenBA. Patient optimism and mastery – do they play a role in cancer patients‘ management of pain and fatigue? J. Pain Symptom Manage.36(1) , 1–10 (2008).

 PubMed Web of Science ®Google Scholar

Miles CL , PincusT, CarnesD et al. Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs. Eur. J. Pain 15(8) , 775.e1–11 (2011).

 PubMed Web of Science ®Google Scholar

Vowles KE , McCrackenLM, EcclestonC. Processes of change in treatment for chronic pain: the contributions of pain, acceptance, and catastrophizing. Eur. J. Pain11(7) , 779–787 (2007).

 PubMed Web of Science ®Google Scholar

Hadjistavropoulos H , ShymkiwJ. Predicting readiness to self-manage pain. Clin. J. Pain23(3) , 259–266 (2007).

 PubMed Web of Science ®Google Scholar

Turner JA , HoltzmanS, ManclL. Mediators, moderators, and predictors of therapeutic change in cognitive–behavioral therapy for chronic pain. Pain127(3) , 276–286 (2007).

 PubMed Web of Science ®Google Scholar

Escolar-Reina P , Medina-MirapeixF, Gascón-CánovasJJ, Montilla-HerradorJ, Valera-GarridoJF, CollinsSM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. Arch. Phys. Med. Rehabil.90(10) , 1734–1739 (2009).

 PubMed Web of Science ®Google Scholar

Janke EA , SpringB, WeaverF. The effect of message framing on self-management of chronic pain: a new perspective on intervention? Psychol. Health26(7) , 931–947 (2011).

 PubMed Web of Science ®Google Scholar