Thursday, May 20, 2010

Coping Skills Essential for Managing Chronic Pain

Conference NotesSpeaking at the American Pain Society’s annual scientific meeting in early May 2010, Francis J. Keefe, PhD, from the Pain and Palliative Care Initiative at Duke University Medical Center, suggested that how individuals cope with and appraise disease-related pain, such as from arthritis or cancer, is related not only to their experience with pain but also to their neurobiological and psychological functioning. In his presentation, he said, “We are clearly observing that studies of coping help us to better understand variations in pain and disability.”

“What seems to be especially important in comprehending persons with disease-related pain is catastrophizing, or the tendency to focus on and exaggerate the threat value of painful stimuli and negatively evaluate one’s own ability to deal with pain. We already know that pain catastrophizing is key to understanding chronic pain,” he added.

Research is helping to explain the neuromechanisms underlying coping with pain. For example, Keefe noted that in a recent study of responses to pain in the brain cortex and the relationship to catastrophizing, it was evident that a cortical vigilance network is engaged during mild pain. However, with more intense pain, diminished modulation in the prefrontal cortex impedes a person’s ability to disengage from and suppress pain. [We interpret this to mean that intense pain overwhelms the patient’s ability to call upon cognitive control (or thinking) centers in the cortex to assist in self-managing the pain experience.] On the other hand, coping skills training protocols include helping patients to re-conceptualize the pain experience and gain more control through training in relaxation, activity pacing, cognitive restructuring, distraction, and guided imagery.

Keefe cited evidence from a recent review of cancer pain studies that showed coping skills training (CST) interventions using imagery or hypnosis yielded consistently beneficial effects, although the ideal components and tailoring of CST remain to be defined. Promising results also were evident in a pilot study of yoga practice for women with metastatic breast cancer, he reported. “When women practiced more on a given day, they experienced more improvements the next day in pain, fatigue, vigor, acceptance, and relaxation.” In summary, Keefe proposed that developing and refining interventions to enhance pain coping can lead to major advances, including improvements in the quality of life and reductions in the suffering of many individuals with disease-related pain.

COMMENTARY: Keefe emphasized that understanding the underlying neuromechanisms of disease-related pain and benefits of coping skills training can help to develop more effective and specific pain therapies. Indeed, as we have been discussing in our ongoing postings on “Pain and the Great Brain Robbery” [blogpost series here], chronic pain appears to provoke neurobiological changes that selectively remodel brain structures, largely in the limbic system and closely associated higher-level cortical centers. Certain interventions, such as yoga, hypnosis, guided imagery, stress reduction, and others may help to reverse those structural aberrations and restore more normal brain function to achieve better long-term pain management. We will continue to report on the research evidence in support of this.

> Keefe FJ, Somers TJ, Kothadia SM. Coping with Pain. IASP Pain Clin Updates. 2009(Oct);17(5) [
available here].
> Physical and Psychological Functioning Important to Patient Coping and Appraisal of Disease-Related Pain. Newswise [American Pain Society press release]. 2010(May 6) [
available here].