Evidence for Multiple Pain Care Modalities

First, it important to highlight that there is no “magic bullet” for individuals who present with chronic pain. Indeed, past research has shown that patient engagement in pain rehabilitation relies on three things: patient capability, opportunity, and motivation (more on this below).² And while professional staff may vary from one practice setting to another, it has long been recognized that the complexities of chronic pain require the collaborative expertise from multiple disciplines, including pain specialty anesthesiologists, osteopaths/chiropractors, physiatrists, psychologists, pharmacists, registered nurses, and other providers.

A few additional points, all worthy of sharing with patients:

  • Clinical trials have indicated the comparable efficacy of numerous diverse treatment interventions, such as acupuncture, behavioral therapy, exercise therapy, and NSAIDs for chronic non-cancer pain.³
  • The reduction of pain after treatment at an interdisciplinary pain rehabilitation program has been reported to be significant.⁴⁻⁶
  • Non-traditional modalities have been found to perform as well as traditional treatments.⁷
  • Reductions in pain severity demonstrated with psychological interventions were similar to those noted with pharmacological, interventional, and physical and rehabilitative approaches.⁷
  • Among psychological approaches, current research indicates that behavioral therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy, stress management, emotional disclosure, biofeedback, and hypnosis, perform similarly.⁵⁻⁶˒⁸⁻¹¹
  • There is promising scientific evidence to support the use of CIH, such as acupuncture, mindfulness meditation, music, yoga, tai chi, massage, and spinal manipulation, for chronic non-cancer pain conditions.¹²
  • The use of CIH has also shown promise in specific conditions, such as low back pain, osteoarthritis, rheumatoid arthritis, headaches, and neck pain, and there is preliminary data for its use with fibromyalgia and irritable bowel syndrome.¹²
Shared Decision-Making in Pain Treatment Choice

Treatment recommendations should be a function of fit, for both the provider and the patient. Clinicians are likely to recommend treatments for which they genuinely feel they can advocate, using a light-handed, supportive approach, educating about the pros of treatment compliance, the cons of noncompliance, and the role of patient-provider negotiations in treatment planning.¹³ For the patient, fit can be determined using a motivational interviewing approach to determine with which treatments they are most likely to engage, including what resources are readily available and what treatments resonate with them.

Providers have historically been viewed as the authority on treatment planning. However, the field of pain management today acknowledges the importance of including patients in treatment planning, a process referred to as “shared decision making (SDM).” SDM can increase patient engagement but requires that the patient be aware of their role and have a positive attitude toward SDM.¹⁴

Factors Affecting Patient Engagement

Patient engagement behavior has been shown to be influenced by both external (opportunity) and intrapersonal variables (capability and motivation). A recent study identified these factors as contributing to patient engagement in chronic pain rehabilitation:²

  • capability – improving patient knowledge and cognitive skills for behavioral regulation, such as action planning, which could also benefit time-management
  • opportunity – a balanced life situation that enables time to be devoted to the treatment and includes social support and easily accessible and affordable resources and services
  • motivation – increasing patient levels of self-efficacy and autonomous motivation, which were noted to be influenced by levels of perceived capability

It is also important for healthcare providers to communicate the effectiveness of interdisciplinary, biopsychosocial treatment to patients in a way that will increase buy-in and treatment adherence – especially the impact of non-traditional interventions. This can be a challenge when clinicians are navigating high caseloads (more on pain physician burnout), which offer less time with each patient. It is especially problematic considering that patients already report that they do not have enough time with their providers and often do not feel heard.¹⁶

Additionally, without adequate explanation, referral to non-traditional treatments, such as psychological and CIH approaches, can further make patients feel that their experiences of pain are not well understood. Providing brief explanations that incorporate and acknowledge patients’ experiences are imperative.

10 Ways to Get Patients on Board with Treatment Plans

A sales pitch is a concise, persuasive speech, typically used in business, that explains the treatment plan, communicates its value, and encourages patient engagement.²¹ Seeing that the US healthcare system is a trillion-dollar industry, it only makes sense we use some of the tools used in the business sector. The following is a review of 10 sales pitch ideas and examples of how to use them in the field of pain medicine.

1. Lead with a Question

Start your visit discussion with a question that compels the patient to see their problem from a different perspective. If the question promises valuable information, they’ll want to know the answer and will stay engaged through the conversation.

Example: “How is your current pain management plan working for you?” This question hints at important information they may be missing and makes them reconsider their current strategy. The front-line provider can provide an answer that aligns with their values.

This step-process starts by stating a truth. Then, introduce another truth that contradicts the first one. Finally, introduce the plan and show how it can resolve the problem.

Example: The clinician explains that opioid medications do help relieve pain in the short term. Then, they contradict this truth by stating that continued use of opioid medications may lead to tolerance, withdrawal, and addiction. The solution is to explore other non-pharmaceutical options currently available to treat chronic pain, such as acupuncture.

3. Tell a Good Story

People remember stories more than facts and stats. Once a patient is emotionally invested in your story, they will be more likely to care about the treatment plan.

Example: Share success stories of some of other patients who have weaned off of opioid medications using a multidisciplinary approach that includes less invasive modalities, such as behavioral programs.

4. Use Genuine Flattery

Adulations will get you everywhere. People like being complimented, so use this to your advantage.

5. Follow the Rule of Three

Instead of overwhelming a patient with too many facts, choose three key elements that you want them to retain.

Example: “A comprehensive pain management plan may have more than three approaches, but we can start with these 3 steps: begin to reduce opioid medications, schedule an appointment with an acupuncturist, and consider an intervention, such as an injection/procedure.”

6. Create a Sense of Urgency

Have you ever thought you were about to convince a patient only to have them drag their feet? It sometimes helps to create a sense of urgency so the patient feels compelled to act.

Example: When proposing that a patient join a pain therapy group, mentions that there may be “room for a few additional patients” at the moment. This encourages the patient to decide right away to avoid missing out on an opportunity to explore psychotherapy.

Words can only go so far. Instead of overexplaining how treatments work, let the patient trial the therapy. When a person has the chance to see the treatment in action, they’ll understand how it works and why they need it.

Example: “In this video, you will see how the treatment I am recommending (CBT or SCS, for example) may help improve your pain; plus a patient shares how the lessons they learned have changed their life.”

8. Acknowledge the Patient’s Emotions

Emotions are a powerful tool. Acknowledge a patient’s feelings as they arise and address any concerns expressed.

Example: Your patient might feel stressed about weaning off their opioid medications. Coach the patient through this process and assure them that you will continue to be available and receptive.

9. Show Supporting Data

While you don’t want your pitch for a particular treatment plan to seem dry, feel free to toss in a few hard facts to. You need your patients to trust you, and for some people, objective data sets their mind at ease.

10. Remember the Patient is a Person

At the end of the day, your pitch is all about convincing the patient to engage in the treatment plan. Tailor your pitch to each individual instead of.

Example: The treatment plan I am outlining is specific to your needs. We need to consider how continuing opioid medications can be harmful, especially when you are currently using illicit substances, have been diagnosed with hepatitis C, and have a history of lung disease.

Practical Takeaways

  • Biopsychosocial treatments are recommended for the treatment of chronic non-cancer pain
  • Patients often expect prescribed medication to treat their pain; it is important for clinicians to provide information in a way that motivates them to engage in psychosocial interventions
  • Providers have limited time with each patient, making concise communication crucial
  • Using “sales pitch” techniques while encouraging shared decision-making can be an effective way to motivate patients to utilize interdisciplinary treatment. This includes asking questions, listening, and using narratives.
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