Psychological approaches to chronic pain management: part 1

Aims and objectives. The aim of this paper is to provide an overview of the theoretical basis and application of psychological interventions used in the management of chronic pain. In doing this, psychological factors mediating pain and disability will also be reviewed. Background. A biopsychosocial model of chronic pain is widely purported and pain management is often based upon cognitive–behavioural principles as psychological factors meditating pain and disability have been found to include emotional, cognitive and behavioural components. Conclusions. This paper provides support for a biopsychosocial model of and for the effectiveness and efficacy of psychological interventions for the management of chronic pain conditions. Relevance to clinical practice. The application of psychological approaches to chronic pain management is reviewed and discussed. The way in which psychological approaches may be integrated specifically into nursing management of chronic pain is discussed in a later paper.     

Nursing leadership in a chronic pain management group approach

Dysvik E. & Furnes B. (2012) Journal of Nursing Management 20, 187–195
Nursing leadership in a chronic pain management group approach Aim To explore and debate nursing leadership and challenges on organizational and group levels when conducting rehabilitation groups for people suffering from chronic pain. Background Group approaches based on cognitive behavioural therapy are generally described as effective. Leadership in group approaches offered to people suffering from chronic pain is a great challenge for nurses on an organizational as well as a group level. Methods One overall leader and nine group leaders conducting 13 groups constituted the sample. Qualitative content analysis was used by identifying categories, subthemes and themes. Results The results from the content analysis revealed one main theme (‘Complexity in nursing leadership’) and three subthemes (‘Challenges in leadership on organizational level’, ‘Challenges in leadership on teamwork level’ and ‘Challenges in leadership on group level’. Conclusions The results show how important it is to have firm overall leadership and trained group leaders with a common purpose, interdependent roles and complementary skills, who are thus well prepared to prevent or deal with challenging group processes. Implications for nursing management The leaders of both levels, which are highly interrelated, should have a current theoretical understanding of pain theory, group leadership skills and a cognitive behavioural approach.     

The nursing management of pain in older people

Effective pain management requires a combination of complex nursing skills, particularly so if patients are cognitively impaired. This article examines the skills nurses need to manage pain in older people and the tools that can help quantify a subjective experience. It also examines the pharmacological management of pain and non-pharmacological approaches that can support analgesia and help reduce pain.     

A social cognitive model for health education/health promotion practice

AIM: To investigate the place and validity of contemporary social cognitive models for health education practice in nursing settings and, in doing so, develop and put forward a specific model for this purpose. BACKGROUND/RATIONALE: The last decade or so has seen a marked increase in the amount of health educational/health promotional activities that nurses are expected to undertake. This has followed on from concerted calls to make health education a familiar and recognized part of nursing practice. Despite this, past and current evidence identifies that nurses have been, and continue to be, ineffective and inconsistent health education practitioners. Where health education activity does take place it tends to centre specifically on social cognitive behavioural change strategies. Subsequently, it is argued here that any failure on the part of nurses successfully to apply health educational initiatives into practice has been compounded by the lack of any nursing-specific social cognitive model process. This paper seeks to redress this imbalance by putting forward the case for such a model, developing it, and demonstrating how it can be incorporated into the practice setting. METHOD: A systematic review of the literature has been conducted and the article draws upon this in order to develop an evolving theoretical perspective for health education practice. The proposed model has evolved from this new perspective. Development of this model has drawn on contemporary social cognitive behavioural models--using them as a means to develop a further conceptual framework for nursing. CONCLUSION: Social cognitive behavioural models are valuable tools that nurses can incorporate routinely into existing frameworks of practice. The proposed model is designed to make the adoption of health-related behavioural change in clients easier and more realistic. If the current situation continues whereby social cognitive behavioural models are not adopted as a concerted and routine part of nursing practice, then nursing may well continue to fall behind other health professions in the discipline of health education.     

Pain management 2: the use of pyschological approaches to pain

This article is the second of a two-part series looking at the psychological and social factors which affect pain perception. The first article (Vol 10(14): 903-11) examined neurophysiological and psychological factors of pain perception. This article considers the importance of the nurse-patient interaction in the management of patients' pain. It outlines the adoption of several psychological approaches which could be utilized by nurses when dealing with patients in pain. The need to encourage a feeling of control over pain is discussed in relation to the use of patient-controlled analgesia and the development of positive coping skills. The value of good communication skills is emphasized as being essential in encouraging patients in pain to utilize these psychological approaches.     

Pain management 1: psychological and social aspects of pain

This two-part article presents psychological and social factors which affect pain perception and response and the implications of these for nursing practice. In this article, the complex interactions between neurophysiological and psychological factors are outlined and theories of pain perception and ways in which the pain experience can be modulated are presented. The role of psychological factors, attitudes, beliefs and expectations of both patient and practitioner, pain behaviours and ability to cope are discussed. In the second part, these are further elaborated with particular reference to the nurse-patient interaction. The use of psychological approaches to augment clinical practice, such as education, reduction of anxiety and improving coping ability, are suggested. Finally, the importance of communication skills in pain management is addressed.     

Chronic Pain Syndrome: Nursing Assessment and Intervention

Chronic pain is a major health problem in the United States. People with chronic pain syndrome are a subgroup of patients with chronic pain who experience high levels of pain, functional impairment, and depression. Because chronic pain syndrome is a complex multidimensional health problem, nurses must use their expert knowledge and skills in pain management and in rehabilitation nursing to help patients improve their health status and quality of life. This article discusses the nursing assessment and management of chronic pain syndrome as well as an assessment tool that the author has helped develop.     

Pain management and nursing care--results of a review of the literature

Especially for patients with chronic conditions, the ability to cope with the experience of illness in their daily lives is essential for the quality of life. An analysis of the international literature, of German nursing textbooks and journals was carried out to determine the dissemination of the state of the art of pain management. International research findings indicate a wide gap between the state of the art and pain management practice. Multidisciplinary role model programs where nurses play a major role as change agents have proved to be an effective strategy to change the institutional practice of pain management. In Germany, pain therapy as a medical discipline as well as academic courses in nursing were only institutionalized in the last decade. As a consequence pain research and therapy remained the domain of medicine and psychology up to now. Enhancing knowledge and educative skills of nurses will not only promote the quality of care. It is a key concept of professionalization in nursing.     

Psychological needs of patients with functional bowel disorder

Psychological processes have an important role in functional bowel disorder (FBD), with a high incidence of psychological distress experienced by this patient group. One way of conceptualising illness, particularly chronic conditions such as FBD, is within a biopsychosocial framework, where the interaction between biological, behavioural and cognitive processes and the social and physical environment define the illness experience. Therefore, in addition to medical treatment, patients with FBD and concomitant psychological difficulties should be offered psychological intervention. This article describes several psychological approaches and discusses how these might be delivered in practice.     

Is adherence to pain self‐management strategies associated with improved pain,depression and disability in those with disabling chronic pain?

There is generally good evidence that pain management interventions that include self‐management strategies can substantially reduce disability and improve psychological well‐being in patients with chronic pain. Reductions in unhelpful responses, especially catastrophising and fear‐avoidance beliefs, have been established as key contributors to these gains. In contrast, there is surprisingly little evidence that adherence to self‐management strategies contributes to achieving these outcomes. Difficulties in defining and measuring the use of pain self‐management strategies have been obstacles for this research. Using a pragmatic way of assessing the practice of specific strategies this study investigated their ability to account for changes in pain, disability and depressive symptoms after a 3‐week cognitive‐behavioural pain management program. The post‐treatment outcomes on these dimensions were found to be statistically and, for many, clinically significant. Consistent with previous research, reductions in catastrophising and fear‐avoidance beliefs, and increased pain self‐efficacy beliefs, were also associated with these gains. But the key new finding was that there was a clear gradient between adherence to specific self‐management strategies and reductions in pain, disability and depressive symptoms. Furthermore, adherence to the self‐management strategies was predictive of better outcomes even after controlling for the moderating effects of initial catastrophising, fear‐avoidance and pain self‐efficacy beliefs.     

Gynaecomastia: a case study review of the effect of hormone therapy in the management of prostate cancer

In the management of prostate cancer, gynaecomastia and breast pain can be a significant problem for men treated with hormonal therapy, affecting not just their physical but also their psychological and sexual well‐being. Prompt recognition, evaluation and management are therefore essential. Urology nurses involved in the assessment, treatment and follow‐up of this patient group across the patient pathway can play a key part in identifying the problem and addressing the issue of gynaecomastia, which may positively affect subsequent patients outcomes. This paper examines the causes, evaluation and current management of gynaecomastia culminating in a case study review.     

The strengths and weaknesses of cognitive behavioural approaches to treating depression and their potential for wider utilization by mental health nurses

Depression is widely acknowledged to be the major factor implicated with suicide, an enormous financial cost on the economies of western countries and a source of intense despair for millions of people around the world. A steady stream of articles are published both in popular, generic and specialist nursing journals that illustrate the potential of cognitive behavioural therapies in the treatment of depression. Should these therapies be restricted for use by registered therapists or do the techniques have a wider application? The marketing of these approaches for use by nurses prompted a review of the purported strengths and weaknesses of these approaches in comparison with other possible alternatives. Many mental health nurses in community settings already use cognitive behavioural approaches with clients. Here it will be argued that several of the recognized strengths of cognitive behavioural approaches lend themselves to incorporation in nurse–patient interactions in varied in‐patient settings by nurses who spend protracted periods of time with depressed patients but lack formal therapist qualifications and do not consider themselves counsellors.     

Nurse preparedness for the non‐communicable disease escalation in Thailand: A cross‐sectional survey of nurses

Chronic diseases are now the largest cause of mortality in Thailand, and form an increasingly large portion of the healthcare landscape. In the Thai health system, many patients with chronic conditions receive care and disease management services from nurses, yet specialized training in chronic diseases is not currently part of standard nursing degree programs. Given the evolving epidemiology of the Thailand population, we questioned whether practicing nurses remain confident in their knowledge and skills in chronic disease management. We conducted a cross‐sectional, self‐efficacy survey of nurses in eight randomly‐selected provinces in Thailand, receiving 468 responses. Nurse self‐efficacy was analyzed in prominent chronic disease types, including cancer, hypertension, diabetes, heart disease, cerebrovascular diseases, and pulmonary diseases. Factors, such as geographic location, education level, continuing education experience, and hospital size, were found to significantly affect nurse self‐efficacy levels; nurses highly prioritized additional training in heart diseases and cerebrovascular diseases, followed by hypertension, cancer, and diabetes.     

Improving geriatric mental health nursing care: making a case for going beyond psychotropic medications

Providing high-quality mental health nursing care should be an important and continuous preoccupation in the gerontological nursing field. As the proportion of elderly people in our society is growing, the emphasis on high-quality care will receive increasing attention from administrators, politicians, organized groups, researchers and clinical nurses. Recent findings illustrate unequivocally the important contribution of nurses to achieving the goal of high-quality geriatric care. However, the quality of care for the elderly with psychological difficulties has not been addressed. The objective of this article is to illustrate that while nurses can accomplish much to improve the well-being and mental health of the elderly, their skills are often underutilized. Psychotropic drugs are often the first-line interventions used by health-care professionals to treat mental health concerns of elderly persons. Alternative therapies that could be implemented and evaluated, such as psychological counselling, supportive counselling, education and life review, are infrequently used. Nevertheless, current scientific data suggest that it would be very advantageous if nurses were to play a dominant role in the care of elderly people who are depressed or experiencing sleep pattern disturbances. The same can be said about elderly chronic users of benzodiazepines, as well as those with cognitive impairment. Evidence for the use of psychotropic medications as a viable treatment option for the elderly both in the community and in the long-term care setting who are experiencing mental health challenges is examined. Alternative non-pharmacological approaches that nurses can use to augment care are also briefly discussed.     

A multidisciplinary approach to chronic pain

Chronic pain often is frustrating to nurses and patients, since many times it has not been responsive to traditional medical approaches. The purpose of this article is to discuss the chronic pain syndrome and the role of nursing within a multidisciplinary chronic pain rehabilitation program designed to return the patient to a functional lifestyle. The purpose and rationale for each treatment modality within the pain management program is described, although the treatment plans are individualized for every patient. Nurses play a crucial role, because they are the only professionals who are constantly available to the patient. Nurses collect data and continually assess the patient to develop comprehensive nursing care plans. In this intensive educational program, nurses also assist in teaching the patient positive health practices to control the pain. Further evaluations of these chronic pain rehabilitation programs are needed.     

A conceptual framework for studying child adaptation to Type 1 diabetes

Understanding the challenges of managing a chronic illness, nurses provide a key component of care to patients and families who struggle daily with the demands of self-management and the balance of daily life challenges. Even though nurses empathize with the issues of chronic illness management, the complexity of managing such clients has not been articulated in a theoretical or research base. Hence, the nursing process related to facilitating adaptation to childhood chronic illness remains in a formative stage. My article presents a conceptual framework that can guide the study of children and families coping with children with Type 1 diabetes. The framework also may prove useful for other chronic illnesses.     

Postoperative pain 1: understanding the factors affecting patients' experiences of pain

Management of postoperative pain is complex and multidimensionalandits effective management presents challenges to nurses. Failure to control pain can result in long term complications, including chronic post surgical pain. This first article, in a two part series, explores the physiological mechanism involved in the perception of pain and the role of psychological and environmental influences on how patients respond to it. Part 2, to be published next week, explores the principles of patient assessment and management of postoperative pain.     

The nursing management of pain in older people

This article examines the complex skills nurses need to manage pain in older people and the tools that can help quantify a subjective experience. It also examines the pharmacological management of pain and non-pharmacological approaches that can support analgesia and help reduce pain.     

Attention management as a treatment for chronic pain

Attention management is often included in cognitive‐behavioural treatments (CBT). The aim of this study was to evaluate the effects of attention management strategies in the treatment for chronic pain. The present pilot study consisted of six weekly 90‐min treatment sessions and was based on a CBT attention management manual describing techniques such as attention diversion, imagery and mindfulness exercises. The intended outcomes were reduction in pain‐related anxiety and hypervigilance to pain and decrease in pain impact of everyday life, measured by self‐report. Information was collected at baseline, pre‐treatment, post‐treatment, and at 3 and 6 months follow‐up. The results at the end of treatment, and at 3‐month follow‐up, show significant reductions in pain‐related anxiety, hypervigilance and interference of pain (effect sizes 0.40–0.90). Reduction in pain‐related interference and anxiety remained at the 6‐month follow‐up. The results indicate that attention control skills can be a useful method to reduce anxiety in the short term. Clinical implications of the results are discussed.