Positive Pain Coping Strategies for Knee Osteoarthritis
By: Marian Thomas Sudano
Background:
Before entering PT school, I had a background in biology and psychology. As we began learning about behavioral theories in our Health and Wellness course this past fall, I realized that concepts surrounding pain neuroscience and human behavior modification theories were a way for me to bridge my PT practice and my interests together. This past fall, I completed my critically appraised topic about the use of Web-based modules to teach pain coping strategies. These modules taught patients with knee OA about their diagnosis, basic pain science and pain coping strategies (such as distraction, pleasant activity scheduling). The research showed that the use of online modules had a small effect on decreasing pain, improving function, increasing self-efficacy and increasing the use of self-management behaviors. This made me wonder if an in-person physical therapist delivered pain coping strategy program could be more effective.
When completing my literature review, I wanted to know how these pain coping strategy training programs (PCST) worked when used in conjunction with physical therapy. I found that these training programs are effective, but can be time-consuming (typically patients received programs 1 hour per week for 8 weeks along with physical therapy). These PCST programs did however have a minimal positive effect on pain and patient self-efficacy which translates into being able to better cope with their pain in daily life and perform more functional activities. Physical therapists commonly address pain from a biological point of view during our treatment. However, when physical therapists address the psychological aspects of pain and teach patients how to actually cope with their pain, we can allow our patients to become more independent in their self-care.
The Project:
With this research in tow, I decided to create a mini educational session about pain science and pain coping strategies. I targeted my presentation to patients with knee OA. The goal for my presentation was skill acquisition – I hoped that by explaining their diagnosis, the components of pain perception along with teaching concrete pain coping strategies, the participants would be able to reduce their pain and improve their self-efficacy by utilizing these coping techniques. Overall, the post assessment showed a 20-point increase in scores indicating that the participants did learn more about their condition and pain coping strategies. However, since I only completed one post assessment immediately after the education, I am unsure how long these effects will last (the studies I found completed sessions 1x a week for at least 8 weeks total). I also found a negligible increase in self-efficacy after the presentation. Here’s the handout I provided that summarized the information from the presentation.
Reflection:
Overall, this experience taught me that pain is more than a biological experience; it has psychological components as well. We cannot continue to address pain (especially chronic pain conditions) from a purely biological/musculoskeletal standpoint and expect positive results. We must understand the other components behind the pain experience to be able to explain that to our patients in order to change their thought process about pain and allow them to cope with it (and as my presentation showed me, education only may not always work and may need to be repeated).
This was the first time I had presented to a patient population rather than clinicians/students. This presentation taught me how to improve my presentation skills to an older population as well as answer questions from different personality types. I learned that people may listen to the education and evidence behind pain science, but may not accept it or be willing to apply these practices to daily life. I also recognized the need for more interactive activities throughout the presentation in order to ensure that the participants were processing and understanding the information. I believe the presentation feedback was a valuable tool in improving my general communication skills with patients.
Acknowledgement:
This Capstone project and presentation required an immense amount of work and I would not have been able to do it without my committee members. First, my professor Dr. Carla Hill for introducing me to this topic, helping me do the research, providing feedback about the presentation and for keeping me on track throughout the project period. I would also like to thank Jamy McGee from the UNC Wellness center for looking over my materials, creating advertisements for my program, helping with the general logistics for the program and providing me great feedback about my presentation skills. Finally, I would like to thank Dr. Mike Gross for providing specific feedback to my presentation and handout.
Consolidated List of Materials:
6 Responses to “Positive Pain Coping Strategies for Patients with Knee Osteoarthritis”
Marian Thomas Sudano
Korre –
It was definitely a different experience presenting with patients rather than clinicians! During the questioning, it was really hard for me to be able to communicate biomechanics concepts to patients using lay people terms rather than PT words.
However, not only was this a valuable experience in communication, it was also important for providing education to patients about what they can gain from physical therapy and what to expect during a PT session. I think by holding these types of inservices to the public, we can broaden patients’ knowledge about what physical therapy can do for them.
Marian
Marian Thomas Sudano
Christie and Genevieve –
Thanks for looking over my materials. Christie, I do not think I actually used these pain coping strategies when I was treating patients, but I know Jon Hacke had his patients do a lot of deep breathing when I shadowed him for ICE. In my own practice, I hope to implement pain coping strategies within a HEP so the patient can be practicing the skill daily. I think the hardest part for me will be to effectively communicate why these strategies work and are a valuable use of time; I am thinking about asking for the “Explain Pain” book for my birthday!
G, I am glad you are already using some of these strategies for your patients. It’s crazy how easily a distraction, such as conversation, can help out patients. Here is a link for some more specific verbal strategies you can use with patients to help them cope with pain:
http://www.spine-health.com/conditions/chronic-pain/11-chronic-pain-control-techniques
It includes strategies such as counting backwards and “transferring” your pain to a different part of the body. I feel like these are practical methods that could be easily taught during a treatment session.
Marian
Genevieve Monroe
Marian
Wow, I am impressed with your ability to simplify a very complicated topic in a professional and succinct manner! When going over the pain module last semester, I wondered how I could discuss pain coping strategies with patients based on the current literature. The handout you created and the background information in you PowerPoint presentation were both extremely helpful. After reading through your literature review, I find that while the effects may be minimal and that most programs are completed electronically, they have been found to be successful.
While I have been completing ICE this semester, I have been able to initiate the use of pain coping strategies in patients with low back and knee pain. Explaining the pain scale in detail, discussing the difference between chronic and acute pain, providing guidelines for exercise up to the point of pain, implementing breathing strategies, and using visual imagery have all been helpful to decrease patient pain. During my clinical rotations, I have also found that when patients are distracted by conversation, they tend to have decreased pain. I was wondering if you found any specific resources for visual imagery or verbal distraction while you were conducting your search.
Thanks again for posting your handouts and PowerPoint, I know that I’ll be sure to use the material in the future ☺
Korre Scott
Marian,
Great work with your capstone project! I really enjoyed looking through your PowerPoint presentation, handout, and other materials you researched and created. This is an important topic to review, since chronic pain is a common occurrence in the clinic yet many therapists do not feel competent in their abilities to teach patients about the biological and psychological components of their pain. Because of this, I’m glad that you chose to provide this material to a group of patients rather than a group of therapists. While both could benefit from this type of presentation, I think you may have gotten a better experience from this capstone by having to tailor it to meet the level of education of your audience. I thought your presentation was tailored appropriately to your audience and that the use of images was likely helpful to explain these concepts!
I think it’s wonderful that you were capable of showing improvements in knowledge on the subject based on the results of your post-test assessment! If patients’ understanding of chronic pain mechanisms can be improved that much from one presentation, it makes me wonder how they’ll benefit if the education was reinforced over a longer period of time.
Again, great job with this capstone project! This is a topic I’ve been more curious about and I definitely enjoyed looking over your materials.
Best of luck as you go out on your final rotation!!
Korre
Christie Clem
Marian,
Great job on your capstone! I agree that teaching pain coping strategies to patients is an important way for them to take a more active role in managing their own pain, but it is something that I haven’t done much of during my clinical rotations. I’m glad I was able to attend your actual presentation at the NW Cary UNC Wellness Center. It was clear during your presentation that you had a thorough understanding of the various pain coping strategies. I know your presentation focused on strategies for knee OA, the list of strategies on your handout can be a good quick reference guide for so many patients no matter what they are being treated for.
Have you used pain coping strategies with any of the patients you have treated during your clinical rotations or ICE? If so, were there any challenges implementing them or getting patient buy in?
Nicole Davis
Hi Marian!
Amazing job on your Capstone, as expected! Your presentation and patient handout materials were visually appealing and easy to follow along with. Also, I loved how you had your audience write a SMART goal!
I think it is important as healthcare providers to look at the patient holistically especially if they present with chronic pain. We have learned in our coursework that chronic pain is not 100% mechanical in nature and your research suggests that there are psychological aspects of pain as well. Though current literature supports the efficacy of relatively lengthy intervention times (i.e. 1 hour sessions), I think physical therapists are perfectly positioned to educate our patients on positive pain coping strategies. I cannot think of many other healthcare professionals that consistently spend > 30 minutes with a patient at a time. As you mentioned, if we can help our patients successfully cope with their pain, they are likely to have greater success with their therapy goals and self-care activities.
Did you by any chance look into how positive pain coping strategies perform with other diagnosis such as low back pain? Or if these strategies were more successful with acute vs. chronic pain? I would suspect that these strategies would also be effective at addressing other pain diagnoses.
Overall, I think you developed a thorough Capstone project. Your hard work really shines through ☺
Nicole