___________________________________________________ Pain Assessment and Management, 2nd Edition
COGNITIVE-BEHAVIORAL THERAPY Working with mental health professionals such as psychologists and psychiatrists is an option for those with severe anxiety and phobias. CBT is one technique that is used and is supported in the literature. The mechanism behind CBT is changing a negative or harmful thinking pattern. Thinking is the cognitive part, and the client’s actions are the behavior part (Medlin- ePlus, 2023). CBT is a psychotherapeutic approach that encour- ages the client to identify negative thoughts, stop negative thoughts, practice using positive thoughts, and develop healthy thinking to help break the pain cycle (MedlinePlus, 2023). Thomas et al. (2021) found that the level of disability, confi- dence, self-efficacy, and occupational performance all improved in patients attending a CBT pain management program for 8 weeks. At the 6-month follow-up, occupational performance and increased confidence maintained the improvements. PAIN MANAGEMENT BARRIERS Barriers to pain management can impact a person’s quality of life (Al Eleiwah et al., 2024). According to Al Eleiwah et al., patients report harmful effects of medications as the greatest barrier to pain management. The development of a treatment plan that includes pain management is impera- tive. All members of the client’s healthcare team should be aware of this plan. Ernstzen et al. (2022) developed a set of guidelines for intervention planning based on available clinical practice guidelines, which were evaluated using the Appraisal of Guidelines Research and Evaluation, Version II. The resulting guidelines include using a person-centered, biopsychosocial approach with collaborative decision-making and empowerment toward self-management. Unnithan and Chidgey (2021) found that patient satisfaction with chronic pain treatment plans was improved when the approaches are outlined and expectations are established prior to the first visit. The treatment plan contains information regarding therapies, both pharmacologic and nonpharmacologic. In April 2024, the Federation of State Medical Boards of the United States adopted the Guidelines for the Chronic Use of Opioid Analgesics as a resource for state medical and osteo- pathic boards (Workgroup, 2024). These guidelines are found in Table 5 and recommend a complete and comprehensive evaluation.
• Progressive relaxation—involves tensing and releasing successive muscle groups while focusing on the differences in sensation that occur (Charalambous et al., 2016). Once learned, this technique can be used to relax muscles at the first signs of tension. The evidence supporting progressive muscle relaxation is inconsistent; however, it is seen to be most frequently supported specifically for chronic low back pain and arthritis pain (Vambheim et al., 2021). BIOFEEDBACK Biofeedback is a treatment modality used to control breathing and heart rate. Clients can improve their understanding of the mind-body connection by making pain visible (Krishnan et al., 2018). An individual learns to control their body and relax muscles. With this control, the fear of pain decreases, which in turn reduces the stress caused by pain and finally reduces the perception of the pain (Krishnan et al., 2018). The three most commonly used biofeedback approaches are as follows. • Electromyography (EMG), which measures muscle tension • Thermal biofeedback, which measures skin temperature • Neurofeedback or electroencephalography (EEG), which measures brain wave activity While there is no conclusive evidence to support the effective- ness of biofeedback, there is data that support the analgesic potential of this intervention when combined with relaxation techniques (Vambheim et al., 2021). Simple and affordable biofeedback devices can be purchased for home use or as a smartphone app. These devices typically measure temperature, heart rate, and breathing rate. A practitioner does not need to be certified in their use to incorporate these devices into an interventional or educational session. HYPNOSIS Hypnosis is a noninvasive therapeutic technique where clini- cians make suggestions that are designed to relax and focus them. In a recent review of the literature, Bicego et al. (2021) reported that hypnosis has the ability to alter the perception of pain. Using functional neuroimaging, changes were seen in all areas of the brain and pain network; the anterior cingulate cortex was fundamental in modulating pain perception. There is some evidence to support the use of hypnosis with clients who experience chronic pain. Taylor and Genkov (2020) report that hypnotherapy is an effective method for reducing a vari- ety of chronic pain conditions. In a review of the literature, Langlois et al. (2022) found that hypnosis treatment lasting a minimum of eight sessions might offer an effective approach for the management of chronic pain.
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