Breaking Bad Behavior Patterns of Chronic Pain


Your new patient hopes you'll be the one find the magic solution for longstanding chronic pain. By its nature, this quest may have become counter-productive. What can you do to help?

Sometimes a vicious and destructive cycle spins its way right into the chair across from your desk. This patient has been striving unsuccessfully for years to find a solution to chronic pain, and has now reached you in search of the magic pill or injection that will solve the problem at last.

Maybe it doesn't exist, at least not yet. What next?

In this recorded interview, psychologist Kevin Vowles PhD describes a form of rethinking that can often break this cycle. In his presentation at the 2014 annual meeting of EULAR [[{"type":"media","view_mode":"media_crop","fid":"26927","attributes":{"alt":"Kevin Vowles PhD","class":"media-image media-image-left","id":"media_crop_6076622939350","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2571","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 121px; height: 155px; float: left; margin: 3px; border-width: 1px; border-style: solid;","title":" ","typeof":"foaf:Image"}}]](the European Union League Against Rheumatism) in Paris, he described the latest research into an intervention similar to cognitive behavior therapy that has sent many of these patients away in a more promising direction.

Here, he discusses how rheumatologists can use this information, along with specific wording to help them guide patients toward thinking about how to get their lives back on track, even if no easy cure is around the corner.

Dr. Vowles is Associate Professor of Psychology at the University of New Mexico.

The questions:

What does the latest research in psychology tell us about the behavior of patients in chronic pain and its relationship to disability?

Tell us a little bit about the treatment that you've been using to address this issue.

Can you tell us about your most recent studies?

It sounds to me like there's a valuable message here for rheumatologists who may have patients and really can't do anything about their pain.

What insights does this offer into the language that rheumatologists might use when facing a new patient who comes in, say, with fibromyalgia and has been attempting to treat this and resolve it for many years?

What about the fact that some patients may see this as the doctor giving up, or simply refusing to try to find a treatment that may actually still exist out there?

Key quotes:

Probably the fundamental message here is that the problem for many with chronic pain is that their behavior isn't getting them the outcomes they want. It's not getting them reduced pain, and it's certainly not getting them reduced disability.

Essentially the primary outcome that we're trying  to achieve is to return patients with pain to a level of functioning that allows them to engage in meaningful activity over the longer term, even if pain continues.

What we ask them to decide is whether ot not this important activity is worth the pain they're going to experience. If it is worth it, the way forward is clear.

If I've learned anything from this 15 years of research... it's that it's absolutely possible to get functioning improved in the absence of reliable reduction in pain.

With these most complex patients, I think it's important for us to talk about pain rehabilitation. ... We've got to decide if one more injection or one more trial of a new analgesic medication is likely to be "the thing" that gets this person's life going again.



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2.  McCracken LM and Gutiérrez-Martínez O. Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy. Behav Res Ther. (2011) 49:267-274. doi: 10.1016/j.brat.2011.02.004.

3.  Vowles KE, Witkiewitz K, Sowden G, Ashworth J. Acceptance and commitment therapy for chronic pain: evidence of mediation and clinically significant change following an abbreviated interdisciplinary program of rehabilitation. J Pain. (2014) 15:101-113. doi: 10.1016/j.jpain.2013.10.002.

4.  Hayes SC, Villatte M, Levin M, Hildebrandt M. Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annu. Rev. Clin. Psychol. (2011) 7:141–168.

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6.  Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain.Br J Gen Pract. (1997) 47:647-652.

7.  Fordyce WE, Fowler RS, Lehmann JF, Delateur BJ. Some implications of learning in problems of chronic pain. Journal of Chronic Diseases (1968) 21:179-190


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