When we talk about psychological interventions for chronic pain we refer to all efforts aimed at helping the person manage pain, learn truths about pain and new pain related skills in order to (a) be in a position to limit the pain sensation they are experiencing, (b) cope with their pain experience in a more effective fashion, so that it does not take over their life, and (c) improve their general sense of wellbeing and quality of life. Such treatments should take into account up to date psychological knowledge and experience and should ideally have been assessed in a clinical setting.
Aiding people who experience chronic pain is a process that begins from the very first moment of contact with a clinician, at interview (e.g. with a doctor, nurse, social worker etc). Education in strategies and techniques that aid in pain management should begin at this point. The necessary characteristic for a successful intervention is individualised treatment which responds directly to the patient's personal goals, life circumstances, and psychological, social and biological characteristics.
algea-18 Treatment can be on a one on one or group basis. In each circumstance, treatment format should be agreed upon both by the professional and person in question. Treatment should entail a certain reasoning and goal setting (mutual agreement on where to start and what is to be achieved), while also including general ground rules (e.g. what is and isn't permitted). Each treatment should entail a set of techniques and methodology, which is either based on extensive clinical experience or proven empirically to lead to better outcomes for chronic pain sufferers. For example, psychological therapies for chronic pain should include:
1) Strategies and techniques that aim to teach patients and their spouses how to cope with pain.
2) Psychological techniques aimed at relieving pain such as relaxation techniques, attention focusing, behavioural scheduling and activation.
3) Techniques aimed at stress relief and emotional management of chronic pain and the difficulties associated to it.
4) Behaviour change techniques for avoidance behaviours related to movement, activities and inappropriate medication intake.
5) Strategies that aid in the change of dysfunctional thinking styles (e.g. catastrophising «I feel awful and things will only get worse in the future»), thoughts that «I can't cope any more», feelings of guilt etc).
6) Other strategies and techniques that aim to aid in the management of familial problems, lack of sleep, and physical stamina. Other areas such as general wellbeing and mental health are targeted.
algea-19 Success is a result of the active participation of specialists, patients and their spouses. Therefore mere participation in groups is not enough and just listening to what the coordinator has to say, may not necessarily make a difference. Commitment on the part of the patient is necessary in order for them to actively help themselves change behaviours and thinking styles where needed, practice techniques outside of group sessions and most importantly, record their weekly progress. Success therefore, does not merely depend on the expert but also the patient. A good collaborative relationship in addition to motivation in the part of all involved is the key to success.
Treatment takes place in many settings and a variety of formats, some in clinical settings some not, some with specialist practitioners some with service users themselves, some short interventions and others longer. Effective treatments are those that focus on the psychological, physical and the practical consequences of pain. Holistic rehabilitation programmes include both medical and psychological elements in parallel. These programmes are run by experts (including general practitioners, Clinical Psychologists, Health Psychologists, Anaesthesiologists, Physiotherapists and Nursing staff etc) under the umbrella term called an interdisciplinary team or, «pain clinics». The effectiveness of such clinics is dependent on the collaboration and united vision which encapsulates the parties involved. Realising this unity is difficult. Multidisciplinary teams are lacking in both Greece and Cyprus.
algea-20 Over the past years programmes that accommodate both patients and their spouses are becoming more renowned. Adjustment to a chronic health condition is a family affair and thus its treatment should incorporate family members. However, this is not often the case in clinical practice. Research suggests that when including family members into treatment, success is not guaranteed, but is often dependent on the degree of participation with treatment, treatment targets and the quality of the spousal relationship. For this reason proper planning is necessary to ensure maximum treatment benefits.
algea-21 Most of the aforementioned programmes have been successful. Since 1960, when the first research paper on chronic pain was published many papers have shown that psychosocial interventions lead to successful pain management and improvement of physical and emotional functioning to a relatively good degree, this is also dependent on the type of pain and the sufferer's personal characteristics. In many circumstances, it has been shown that these types of interventions are more effective than medical interventions. It is noteworthy to say however, that a combination of both is the most effective treatment. As underlined by chronic pain's leading researcher Dennis Turk, one plus one is three as opposed to two, this suggests that combination of treatments for the treatment of chronic pain are a lot more effective than any one treatment alone. Finding more effective treatments to already existing ones is still an issue. Many interventions including hypnosis and systemic psychotherapy have been used in the treatment of chronic pain; however these have shown varied success. Improvements in science and technology, the development of new psychological theories for understanding and changing human behaviour and compiled years of experience reveal new treatment methods that are worthy of assessment.
Our study aims at exploring factors that contribute to patient adjustment from chronic pain in Greece and Cyprus. The better understanding of these associated factors will aid us in achieving our second aim, that of designing an intervention to manage chronic pain. For the development of this intervention, already existing knowledge, patient feedback, new theoretical models, and new treatment methods have been used.
Many successful pain management programmes do already exist, however, researchers continue to find even more effective interventions. We hope that our project ALGEA will contribute to this effort.