Welcome back to SpineIQ’s BackBlog! For the past couple of weeks, we have been discussing one of the main topics that is consistent throughout clinical practice guidelines for low back pain: imaging. This week, we discuss another one of the topics that is consistent throughout clinical practice guidelines for low back pain: self-management.¹ A group of researchers that are leading pragmatic clinical trials for chronic pain, including Dr. Goertz, recently wrote an article with a call to action to improve the implementation of self-management strategies for chronic pain. In this blog, we summarize their call to action and provide clinically relevant suggestions to empower patients to use self-management strategies.

What is self-management?

Self-management has been defined as intentionally attempting to manage your own pain experience.² The potential for self-management is associated with self-efficacy, which is the belief that one can achieve successful pain management. In a previous blog, we discussed that patients tend to feel positive towards self-management, but self-doubt can decrease this positive feeling towards self-management. This is where the provider plays an extremely important role in being able to reassure, foster increased resilience, and empower the patients to work through these periods of self-doubt.³

What are the clinically relevant competencies for self-management?

In the article by Kerns et al. titled “self-management of chronic pain: psychologically guided core competencies for providers”, the authors discuss clinically relevant competencies for self-management. These include the 4 overarching competencies of recognizing the multidimensional nature of pain, pain assessment, pain management, and the clinical and social context. Each overarching competency provides clinicians with suggestions on how to empower patients and promote self-management strategies. Some of the clinically relevant suggestions are:

• Use active listening and motivational interviewing skills to educate on the multidimensional, biopsychosocial nature of pain while acknowledging the patients unique pain experience
• Reassure patient by letting them know that they are in charge, can manage their pain and the effect it has on their life
• Through a shared decision making process, identify barriers and facilitators to self-management and build a plan to empower self-management
• Promote healthy behaviors (e.g., exercise and nutrition), while actively listening and discussing potential barriers to increasing healthy behavior and building a plan through shared decision making to limit the effect of those barriers
• When appropriate, ask to engage friends/family that can help empower patients to get back to doing the things they love to do

Conclusions

The evidence is strong for the importance of self-management for chronic pain. This has led to consistent clinical practice guideline recommendations encouraging clinicians to promote self-management. However, the authors of this article acknowledge the need of a call to action in the implementation of self-management strategies in routine clinical practice. The authors list two key factors that have influenced the slow up-take of self-management for chronic pain: training and reimbursement. We hope that the clinically relevant suggestions in this blog, along with previous blogs on (1) guidance for self-management, (2) how to build successful self-management plans, and (3) barriers and facilitators to supporting self-management, can help increase the knowledge and training of self-management among clinicians. We recognize that this is a very difficult challenge for clinicians, however even one successful patient who has been successful in self-management will provide the momentum and encouragement to both the patient and the clinician. The reward of self-management which is gratifying for the patient and clinician, will yield confidence from staff and other patients who will soon recognize that this practice and practitioner are different.

References:

1. Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86. doi:10.1136/bjsports-2018-099878
2. Medicine I of. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.; 2011. doi:10.17226/13172
3. Bourke MJ, Ferguson D, Cooke M. Patient Experiences of Self-Management for Chronic Low Back Pain: A Qualitative Study. Phys Ther. Published online March 30, 2022:pzac030. doi:10.1093/ptj/pzac030