Skip to main content

Advertisement

SpringerLink
Log in

Providers' roles in enhancing patients' adherence to pain self management

  • Practice Tools
  • Published:
Translational Behavioral Medicine

ABSTRACT

Practice guidelines and empirical research related to pain management encourage clinicians to take active roles in providing education about self management and promoting adoption of a self-management approach. The purpose of the study was to review the relevant literature, summarize aspects of the patient–provider interaction that influence patient engagement in self management for chronic pain, and outline practice recommendations in this area. Review of the literature on aspects of the patient–provider interaction that promote engagement in pain self-management was used. Findings are synthesized into recommendations for providers. Patients benefit from a biopsychosocial and patient-centered approach. Patients are more likely to fully disclose when providers respond empathically, which can improve conceptualization and treatment. Patient education and motivation play important roles in engaging patients in self management. Self management is influenced in part by the patient–provider communication process. Suggestions for communication strategies to facilitate patient engagement in self-management techniques, including empathic discussion of barriers and motivation enhancement, are provided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pain Foundation. Pain facts & stats: prevalence of pain. http://www.painfoundation.org/learn/publications/files/PainFactsandStats.pdf. 2008.

  2. Breuer B, Cruciani R, Portenoy RK. Pain management by primary care physicians, pain physicians, chiropractors, and acupuncturists: a national survey. South Med J. 2010;103:738-747.

    Article  PubMed  Google Scholar 

  3. Committee on Advancing Pain Research, Care, and Education: Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. 2011.

  4. Ospina M, Harstall C. Prevalence of chronic pain: and overview. Alberta Heritage Foundation for Medical Research, Health Technology Assessment. Edmonton, AB; 2002. Report No. 28.

  5. Lame IE, Peters ML, Vlaeyen JW, Kleef M, Patijn J. Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity. Eur J Pain. 2005;9:15-24.

    Article  PubMed  Google Scholar 

  6. Netto EC, Brites C. Characteristics of chronic pain and its impact on quality of life of patients with HTLB-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Clin J Pain. 2011;27:131-135.

    Article  PubMed  Google Scholar 

  7. Sprangers MA, de Regt EB, Andries F, van Agt HM, Bijl RV, de Boer JB, Foets M, Hoeymans N, Jacobs AE, Kempen GI, Miedema HS, Tijhuis MA, de Haes HC. Which chronic conditions are associated with better or poorer quality of life? J Clin Epidemiol. 2000;53:895-907.

    Article  PubMed  CAS  Google Scholar 

  8. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163:2433-2445.

    Article  PubMed  Google Scholar 

  9. Institute for Clinical Systems Improvement (ICSI). Assessment and management of chronic pain. Bloomington: Institute for Clinical Systems Improvement (ICSI); 2009.

  10. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:278-291.

    Google Scholar 

  11. Dixon K, Keefe FJ, Scipio CD, Perri LM, Abernethy AP. Psychological interventions for arthritis pain management in adults: a meta-analysis. Health Psychol. 2007;26:241-250.

    Article  PubMed  Google Scholar 

  12. Eccleston C, Williams AC, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2009; 15.

  13. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26:1-9.

    Article  PubMed  Google Scholar 

  14. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy and behavior therapy for chronic pain in adults, excluding headache. Pain. 1999;80:1-13.

    Article  PubMed  CAS  Google Scholar 

  15. van Tulder MW, Ostelo R, Vlaeyen JW, Linton SJ, Morley SJ, Assendelft WJ. Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine. 2001;26:270-281.

    Article  PubMed  Google Scholar 

  16. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133:581-624.

    Article  PubMed  Google Scholar 

  17. Thorstensson CA, Gooberman-Hill R, Adamson J, Williams S, Dieppe P. Help-seeking behavior among people living with chronic hip or knee pain in the community. BMC Musculoskelet Disord. 2009;10:153.

    Article  PubMed  Google Scholar 

  18. Jordan K, Jinks C, Croft P. A prospective study of the consulting behavior of older people with knee pain. Br J Gen Pract. 2006;26:269-276.

    Google Scholar 

  19. Kiesler DJ, Auerbach SM. Integrating measurement of control and affiliation in studies of physician–patient interaction: the interpersonal circumplex. Soc Sci Med. 2003;57:1707-1722.

    Article  PubMed  Google Scholar 

  20. Piette JD, Schillinger D, Potter MB, Heisler M. Dimensions of patient–provider communication and diabetes self-care in an ethnically diverse population. J Gen Intern Med. 2003;18:624-633.

    Article  PubMed  Google Scholar 

  21. Stewart MA. Effective physician–patient communication and health outcomes: a review. CMAJ. 1995;152:1423-1433.

    PubMed  CAS  Google Scholar 

  22. Balint J, Shelton W. Regaining the initiative: forging a new model of the patient–physician relationship. J Am Med Assoc. 1996;275:887-891.

    Article  CAS  Google Scholar 

  23. Weiss GB. Paternalism modernized. J Med Ethics. 1985;11:184-187.

    Article  PubMed  CAS  Google Scholar 

  24. Maizes V, Rakel D, Niemiec C. Integrative medicine and patient-centered care. Explore. 2009;5:277-289.

    Article  PubMed  Google Scholar 

  25. Stewart M. Towards a global definition of patient centred care: the patient should be the judge of patient centred care. BMJ. 2001;322:444-445.

    Article  PubMed  CAS  Google Scholar 

  26. Murray E, Pollack L, White M, Lo B. Clinical decision-making: physicians' preferences and experiences. BMC Fam Pract. 2007;8:10.

    Article  PubMed  Google Scholar 

  27. Braddock CH III, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. J Am Med Assoc. 1999;282:2313-2320.

    Article  Google Scholar 

  28. Schattner A, Rudin D, Jellin D. Good physicians from the perspective of their patients. BMC Health Serv Res. 2004;4:26-31.

    Article  PubMed  Google Scholar 

  29. Teh CF, Karp JF, Kleinman A, Reynolds CF III, Weiner DK, Cleary PD. Older people's experiences of patient-centered treatment for chronic pain: a qualitative study. Pain Med. 2009;10(3):521-530.

    Article  PubMed  Google Scholar 

  30. Peters S, Rogers A, Salmon P, Gask L, Dowrick C, Towey M, Clifford R, Morriss R. What do patients choose to tell their doctors? Qualitative analysis of potential barriers to reattributing medically unexplained symptoms. J Gen Intern Med. 2009;24:443-449.

    Article  PubMed  Google Scholar 

  31. Salmon P, Ring A, Humphris GM, Davies JC, Dowrick CF. Primary care consultations about medically unexplained symptoms: how do patients indicate what they want? J Gen Intern Med. 2009;24:450-456.

    Article  PubMed  Google Scholar 

  32. Hartz AJ, Noyes R, Bentler SE, Damiano PC, Willard JC, Momany ET. Unexplained symptoms in primary care: perspectives of doctors and patients. Gen Hosp Psychiatry. 2000;22:144-152.

    Article  PubMed  CAS  Google Scholar 

  33. Barry CA, Bradley CP, Britten N, Stevenson FA, Barber N. Patients' unvoiced agendas in general practice consultations: qualitative study. BMJ. 2000;320:1246-1250.

    Article  PubMed  CAS  Google Scholar 

  34. Werner A, Malterud K. It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Soc Sci Med. 2003;57(8):1409-1419.

    Article  PubMed  Google Scholar 

  35. McCracken LM, Turk DC. Behavioral and cognitive–behavioral treatment for chronic pain: outcome, predictors of outcome, and treatment process. Spine. 2002;27:2564-2573.

    Article  PubMed  Google Scholar 

  36. Cedraschi C, Desmeules J, Rapiti E, Baumgartner E, Cohen P, Finckh A, Allaz AF, Vischer TL. Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management. Ann Rheum Dis. 2004;63:290-296.

    Article  PubMed  CAS  Google Scholar 

  37. Ersek M, Turner JA, McCurry SM, Gibbons L, Kraybill BM. Efficacy of a self-management group intervention for elderly persons with chronic pain. Clin J Pain. 2003;19:156-167.

    Article  PubMed  Google Scholar 

  38. Frantsve LME, Kerns RD. Patient–provider interactions in the management of chronic pain: current findings within the context of shared decision making. Pain Med. 2007;8(1):25-35.

    Article  PubMed  Google Scholar 

  39. Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997;127:1097-1102.

    Google Scholar 

  40. Mead N, Bower P. Patient-centered consultations and outcomes in primary care: a review of the literature. Patient Educ Couns. 2002;48:51-61.

    Article  PubMed  Google Scholar 

  41. Mead N, Bower P. Patient-centeredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51:1087-1100.

    Article  PubMed  CAS  Google Scholar 

  42. Fuertes JN, Mislowack A, et al. The physician–patient working alliance. Patient Educ Couns. 2007;66:29-36.

    Article  PubMed  Google Scholar 

  43. Fuertes JN, Boylan LS, Fontanella JA. Behavioral indices in medical care outcome: the working alliance, adherence, and related factors. J Gen Intern Med. 2009;24(1):80-85.

    Article  PubMed  Google Scholar 

  44. Hirsh AT, Atchison JW, Berger JJ, Waxenberg LB, Lafayette-Lucey A, Bulcourf BB, Robinson ME. Patient satisfaction with treatment for chronic pain: Predictors and relationship to compliance. Clin J Pain. 2005;21:302-310.

    Article  PubMed  Google Scholar 

  45. Turk DC, Rudy TE. Neglected topics in the treatment of chronic pain patients—relapse, noncompliance, adherence enhancement. Pain. 1991;4:5-28.

    Article  Google Scholar 

  46. Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74:295-301.

    Article  PubMed  Google Scholar 

  47. Martins RK, McNeil DW. Review of motivation interviewing in promoting health behaviors. Clin Psychol Rev. 2009;29:283-293.

    Article  PubMed  Google Scholar 

  48. Channon SJ, Huws-Thomas MV, Rollnick S, Hood K, Cannings-John RL, Rogers C, Gregory JW. A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care. 2007;30:1390-1395.

    Article  PubMed  Google Scholar 

  49. Olsen JM, Nesbitt BJ. Health coaching to improve healthy lifestyle behaviors: an integrative review. Am J Health Promot. 2010;25:e1-e12.

    PubMed  Google Scholar 

  50. Bennett JK, Fuertes JN, Keitel M, Phillips R. The role of patient attachment and working alliance on patient adherence, satisfaction, and health-related quality of life in lupus treatment. Patient Educ Couns. 2011;85:53-59.

    Article  PubMed  Google Scholar 

  51. Berg C, Raminani S, Greer J, Harwood M, Safren S. Participants' perspectives on cognitive–behavioral therapy for adherence and depression in HIV. Psychother Res. 2008;18:271-280.

    Article  PubMed  Google Scholar 

  52. Owens RA. The caring behaviors of the home health nurse and influence on medication adherence. Home Healthc Nurse. 2006;24:517-526.

    Article  PubMed  Google Scholar 

  53. Liddle SD, Gracey JH, Baxter GD. Advice for the management of low back pain: a systematic review of randomized controlled trials. Man Ther. 2007;12:310-327.

    Article  PubMed  Google Scholar 

  54. Udermann BE, Spratt KF, Donelson RG, Mayer J, Graves JE, Tillotson J. Can a patient educational book change behavior and reduce pain in chronic low back pain patients? Spine J. 2004;4:425-435.

    Article  PubMed  Google Scholar 

  55. Escolar-Reina P, Medina-Mirapeix F, Gascon-Canovas JJ, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. Arch Phys Med Rehabil. 2009;90:1734-1739.

    Article  PubMed  Google Scholar 

  56. Melzack R, Wall RD. Pain mechanisms: a new theory. Science. 1965;150:971-979.

    Article  PubMed  CAS  Google Scholar 

  57. Otis JD. Managing chronic pain: a cognitive behavioral therapy approach. New York: Oxford University Press; 2007.

    Google Scholar 

  58. Jensen MP, Nielson WR, Kerns RD. Toward the development of a motivational model of pain self-management. J Pain. 2003;4:477-492.

    Article  PubMed  Google Scholar 

  59. Becker A, Leonhardt C, Kochen MM, Keller S, Wegscheider K, Baum E, Donner-Banzhoff N, Pfingsten M, Hildebrandt J, Basler HD, Chenot JF. Effects of two guideline implementation strategies on patient outcomes in primary care: a cluster randomized controlled trial. Spine. 2008;33:473-480.

    Article  PubMed  Google Scholar 

  60. Habib S, Morrissey S, Helmes E. Preparing for pain management: a pilot study to enhance engagement. J Pain. 2005;6:48-54.

    Article  PubMed  Google Scholar 

  61. Shutty MS, DeGood DE, Tuttle DH. Chronic pain patients' beliefs about their pain and treatment outcomes. Arch Phys Med Rehabil. 1990;71:128-132.

    PubMed  Google Scholar 

  62. Kerns R, Rosenberg R. Predicting responses to self-management treatments for chronic pain: application of the pain stages of change model. Pain. 2000;84:49-55.

    Article  PubMed  CAS  Google Scholar 

  63. Biller N, Arnstein P, Caudiall MA, Federman CW, Guberman C. Predicting completion of a cognitive–behavioral pain management program by initial measures of a chronic pain patient's readiness for change. Clin J Pain. 2000;16:352-359.

    Article  PubMed  CAS  Google Scholar 

  64. Prochaska J, DiClemente C. The transtheoretical approach: crossing traditional boundaries of therapy. Homewood, Ill: Dow Jones-Irwin; 1984.

    Google Scholar 

  65. Kerns RD, Rosenberg R, Jamison RN, Caudill MA, Haythornwaite J. Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ). Pain. 1997;72:227-234.

    Article  PubMed  CAS  Google Scholar 

  66. Gersh E, Arnold C, Gibson SJ. The relationship between the readiness for change and clinical outcomes in response to multidisciplinary pain management. Pain Med. 2011;12:165-172.

    Article  PubMed  Google Scholar 

  67. Dysvik E, Kvaloy JT, Stokkeland R, Natvig GK. The effectiveness of a multidisciplinary pain management programme managing chronic pain on pain perceptions, health-related quality of life and stages of change—a non-randomized controlled study. Int J Nurs Stud. 2010;47:826-835.

    Article  PubMed  Google Scholar 

  68. Strand EB, Kerns RD, Christie A, Haavik-Nilsen K, Klokkerud M, Finset A. Higher levels of pain readiness to change and more positive affect reduce pain reports—a weekly study of arthritis pain. Pain. 2007;127:204-213.

    Article  PubMed  Google Scholar 

  69. Jensen MP, Nielson WR, Turner JA, Romano JM, Hill ML. Changes in readiness to self-manage pain are associated with improvement in multidisciplinary pain treatment and pain coping. Pain. 2004;111:84-95.

    Article  PubMed  Google Scholar 

  70. Kerns RD, Habib S. A critical review of the pain readiness to change model. J Pain. 2004;5:357-367.

    Article  PubMed  Google Scholar 

  71. Glenn B, Burns JW. Pain self-management in the process and outcome of multidisciplinary treatment of chronic pain: evaluation of a stage of change model. J Behav Med. 2003;26:417-433.

    Article  PubMed  Google Scholar 

  72. Rollnick S, Miller WR. What is motivational interviewing? Behav Cogn Psychother. 1995;23:325-334.

    Article  Google Scholar 

  73. Miller WR, Rollnick S. Motivational interviewing: preparing people for change. 2nd ed. New York: Guilford; 2002.

    Google Scholar 

  74. Lundahl B, Burke BL. The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses. J Clin Psychol. 2009;65:1232-1245.

    Article  PubMed  Google Scholar 

  75. Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005;1:91-111.

    Article  PubMed  Google Scholar 

  76. Lai DT, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation. Cochrane DatabaseSyst Rev. 2010;20:CD006936.

    Google Scholar 

  77. Vasilaki EI, Hosier SG, Cox WM. The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol. 2006;41:328-335.

    Google Scholar 

  78. Spahn JM, Reeves RS, Keim KS, Laguatra I, Kellogg M, Jortberg B, Clark NA. State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change. J Am Diet Assoc. 2010;110:879-891.

    Article  PubMed  Google Scholar 

  79. Scala D, D'Avino M, Cozzolino S, Mancini A, Andria B, Caruso G, Tajana G, Caruso D. Promotion of behavioral change in people with hypertension: an intervention study. Pharm World Sci. 2008;30:834-839.

    Article  PubMed  Google Scholar 

  80. Van Dorsten B. The use of motivational interviewing in weight loss. Curr Diab Rep. 2007;7:386-390.

    Article  PubMed  Google Scholar 

  81. Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I. Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil. 1998;79:475-487.

    Article  PubMed  CAS  Google Scholar 

  82. Friedrich M, Gittler G, Arendasy M, Friedrich KM. Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain. Spine. 2005;30:995-1000.

    Article  PubMed  Google Scholar 

  83. Vong SK, Cheing GL, Chan F, So EM, Chan CC. Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with low back pain: a randomized controlled trial. Arch Phys Med Rehabil. 2011;92:176-183.

    Article  PubMed  Google Scholar 

  84. Basler HD, Bertalanffy H, Quint S, Wilke A, Wolf U. TTM-based counseling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain—a randomized controlled trial. Eur J Pain. 2007;11:31-37.

    Article  PubMed  Google Scholar 

  85. Bursztajn H, Barsky AJ. Facilitating patient acceptance of a psychiatric referral. Arch Intern Med. 1985;145:73-75.

    Article  PubMed  CAS  Google Scholar 

  86. Bonica JJ. Basic principles in managing chronic pain. Arch Surg. 1977;112:783-788.

    Article  PubMed  CAS  Google Scholar 

  87. Bea SM, Tesar GE. A primer on referring patients to psychotherapy. Cleve Clin J Med. 2002;69:114-127.

    Article  Google Scholar 

  88. Rogers CA. The necessary and sufficient conditions of therapeutic personality change. Psychotherapy. 2007;44:240-248.

    Article  PubMed  Google Scholar 

  89. Smith RC, Dwamena FC, Grover M, Coffey J, Frankel RM. Behaviorally defined patient-centered communication—a narrative review of the literature. J Gen Intern Med. 2011;26:185-191.

    Article  PubMed  Google Scholar 

  90. Street RL, Millay B. Analyzing patient participation in medical encounters. Health Commun. 2001;13:61-73.

    Article  PubMed  Google Scholar 

Download references

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. Support for this manuscript was provided by a grant from the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Service (REA 08-266) and from a Program for Research Leadership Award from The Patrick and Catherine Weldon Donaghue Medical Research Foundation and Mayday Fund.

Author information

Authors and Affiliations

  1. Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA

    Lindsey Dorflinger PhD

  2. Pain Research, Informatics, Medical comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA

    Robert D Kerns PhD

  3. Department of Psychiatry, Neurology, and Psychology, Yale University, West Haven, CT, USA

    Robert D Kerns PhD

  4. Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA

    Stephen M Auerbach PhD

Authors
  1. Lindsey Dorflinger PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert D Kerns PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen M Auerbach PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lindsey Dorflinger PhD.

Additional information

Implications

Research: Future research should continue to examine the communication process between patients and providers to determine specific mechanisms through which improved communication within the dyad can lead to positive health outcomes.

Practice: Interpersonal aspects of the provider–patient interaction—including utilization of patient-centered communication skills, information provision about pain and self management, and enhancement of motivation and self efficacy—can all facilitate patient engagement in chronic pain self management.

Policy: Pain guidelines generally emphasize pain self management but provide little information on how providers can facilitate this; information should also be disseminated to providers through guidelines or other channels regarding how to discuss and support patient engagement in self management.

About this article

Cite this article

Dorflinger, L., Kerns, R.D. & Auerbach, S.M. Providers' roles in enhancing patients' adherence to pain self management. Behav. Med. Pract. Policy Res. 3, 39–46 (2013). https://doi.org/10.1007/s13142-012-0158-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13142-012-0158-z

KEYWORDS

Search

Navigation