Session
Topic
Content
6. Relaxation
Basic relaxation training.
• Agenda setting (ask patient to contribute). • Review of previous session: Challenging unhelpful thoughts. • Homework review (Thought Diary, Part 2; review of weekly pleasant activities). • Describe physical stress response system. • Review relaxation techniques for controlling stress. • Teach diaphragmatic breathing and practice. • Ongoing pleasant activities scheduling. • Summary. • Homework review (relaxation practice, review of weekly pleasant activities). • Homework review (Unhelpful Thoughts Diary; review of pleasant events). • Introduce social support, including benefits and different types (Emotional, informational, practical, belonging). • Discuss importance of social support in chronic pain. • Introduce the concepts of helpful and unhelpful social support in chronic pain. • Help patient identify his/her own support system. • Help patient describe aspects of his/her social support system that contribute to independence or to disability. • Address problems with balancing need for independence with need for social support. • Introduce worksheet describing important sources of social support (positive and negative) in patient’s network. • Ongoing pleasant activities scheduling. • Summary. • Agenda setting (ask patient to contribute). • Review of previous session: Relaxation. • Agenda setting (ask patient to contribute). • Review of previous session (social support in chronic pain). • Homework review (People in My Life worksheet; review of weekly pleasant activities). • Introduce topic of energy conservation in pain management.
7. Social support and pain
Role of social support in chronic pain.
8. Pacing and energy conservation in chronic pain
Activity pacing, rest scheduling, and fatigue/energy management in chronic pain.
• Identify potential sources of fatigue. • Introduce the Pain-Activity-Pain Cycle. • Introduce topic of activity pacing. • Discuss avoidance of pain-contingent rest. • Ongoing pleasant activities scheduling. • Summary.
Resources Assessment tools ● The Brief Pain Inventory Website: http://www.mdanderson.org/education-and- research/departments-programs-and-labs/departments-and- divisions/symptom-research/symptom-assessment-tools/ brief-pain-inventory.html The Brief Pain Inventory is available in two formats: the short form, which is used for clinical trials, and the long form, which contains additional descriptive items that may be clinically useful (for example, items that expand the possible descriptors of pain, such as burning or tingling). For brevity’s sake and for the patient’s ease of use, the short form is recommended. The Brief Pain Inventory is owned by Dr. Charles S. Cleeland, and can be purchased through the University of Texas MD Anderson Cancer Center website. ● The Chronic Pain Coping Inventory Website: http://www4.parinc.com/Products/Product. aspx?ProductID=CPCI Designed to assess the use of coping strategies that are typically targeted for change in multidisciplinary pain treatment programs, the Chronic Pain Coping Inventory can be used as a treatment outcome measure, as a screening measure, and to document the necessity of treatment. This assessment tool is maintained by Psychological Assessment Resources (PAR) and can be purchased on their website. ● The West Haven-Yale Multidimensional Pain Inventory Website: https://www.sralab.org/rehabilitation-measures/ west-haven-yale-multidimensional-pain-inventory
The West Haven-Yale Multidimensional Pain Inventory assesses chronic pain in individuals and is recommended for use in conjunction with behavioral and psychophysiological strategies. The measure is based on a cognitive-behavioral theory of pain and emphasizes the role of cognitive, emotional, and behavioral factors in the experience of pain and related disability. It is publicly available at no cost. Copies can be obtained through the U.S. Department of Education-funded Rehabilitation Measures Database. Supplemental Reading ● Barber, J. (1996). Hypnosis and Suggestion in the Treatment of Pain: A Clinical Guide . New York, NY: W. W. Norton & Company. Barber’s guide is considered a standard introductory text for clinicians wishing to incorporate hypnosis into their pain practice. ● Beaulieu, P., Lussier, D., Porreca, F., & Dickenson, A. H. (2010). Pharmacology of Pain . Seattle, WA: IASP Press. This is a useful reference textbook for those interested in a basic scientific exploration of pharmacology in chronic pain. ● Institute of Medicine (IOM). (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research . Washington, DC: National Academies Press. This review manual was published by the National Academies, a private, nonprofit, academic group, in conjunction with the U.S. Department of Health and Human Services. It includes an excellent overview of the scope, nature, and impact of chronic pain as well as a discussion of social and policy-level barriers to effective pain care.
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