Helping patients live with chronic pain
Psychosocial program reduces clinic visits 36%
Americans spend an estimated $90 billion each year in medical claims for chronic pain. The cost of pain clinic services is skyrocketing, and studies indicate that most clinic visits do not result in any change in the chronic or acute condition, one pain expert says.
"Many patients come into the pain clinic unaware that they actually have psychosocial issues that need to be addressed," says Margaret A. Caudill, MD, PhD, director of the pain management program and co-director of the Arnold Pain Center at Beth Israel Deaconess Medical Center in Boston. "We work with an awareness that individual stress levels, attitudes, emotions, behaviors, and environments all affect pain symptoms."
Putting patients in control
Patients with chronic pain often rely on external sources such as physicians for relief and intervention, Caudill says.
"This reliance is not practical because the physician is not always available, especially in managed care environments. We have to give patients coping tools to help them improve their quality of life. Patients need to learn the skills to know how to reduce the suffering. By putting people in control of their own lives, you reduce their helplessness and hopelessness."
Caudill developed a pain management program at Beth Israel Deaconess that teaches relaxation, stress reduction, and meditation to help reduce pain symptoms. "We also try to help patients modify their perceptions of the pain experience," she says.
The program takes place in 10 weekly sessions of 90 minutes each. The goal is to address four components of the pain experience:
· somatic;
· affective;
· behavioral;
· cognitive.
Session 1. The first session introduces patients to the pathophysiology of pain. Patients receive a pain diary to record notes about their pain medication use and any side effects they experience.
Session 2. In the second session, patients receive a relaxation tape and learn how to elicit a relaxation response. Patients also learn breathing exercises. Caudill encourages patients to continue their pain diaries and to practice relaxation techniques daily.
Session 3. Patients learn how to pace themselves by alternating rest with activity. In the third session, patients also learn how to describe pain and other physical sensations in specific, qualitative terms instead of generic, global terms.
Again, Caudill encourages patients to continue their pain diaries and practice relaxation daily. In addition, patients learn to consciously schedule pleasurable activities.
Session 4. In this session, patients receive nutritional guidance related to pain management and simple yoga exercises. Caudill encourages them to monitor their diets and continue keeping their pain diaries and practicing their relaxation exercises.
Sessions 5 - 10. The last six sessions focus on cognitive restructuring. Caudill assesses patients' current communication skills, problem-solving, and coping strategies. She encourages them to continue keeping their pain diaries and practicing relaxation exercises daily. Patients receive communication and cognitive exercises to practice at home.
The program has experienced measurable success. A 1991 study of the Beth Israel Deaconess pain management program found a 36% reduction in pain clinic visits among patients who completed the program. The study included 109 patients averaging 12 physician visits a year who were all members of the same health maintenance organization. The 36% reduction equaled 511 clinic visits at a cost of $45 each for the HMO, or a projected gross savings of $23,000 in the first year.
The potential savings more than offset the cost of providing the program, Caudill says. With staff time, overhead, and administrative costs, delivering the program cost roughly $1,000 per group. The 109 patients in the study were divided into 11 groups for a total cost of $11,000, or less than half the estimated savings.
"Patients must be motivated to improve the quality of their lives for this type of program to work for them," Caudill says. "Case managers must determine whether patients are ready to change their behaviors, or they won't benefit from the skills that we teach. A program like this takes a strong commitment from the patient. You get what you put into them."
[See: Caudill M, Schnable R, Zullermeister P, et al. Decreased clinic use by chronic pain patients: Response to behavioral medicine intervention. Clin J Pain 1991; 7:305-310.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content