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Behavior Patterns and Their Relation to Chronic Pain
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Posted on: 08/16/2007
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Chronic pain is a fact of life for many people. Studies show that fear of pain and avoidance of activity can cause further disability. In this study, researchers look at other patterns of activity and their impact on pain.
Almost 300 men and women with chronic pain were included. More than half had back pain. The rest had pain elsewhere in the body. There were patients with leg, shoulder, arm, neck, upper back, head, face, or mouth pain. Everyone filled out several surveys. Data was collected on pain levels, medication use, and work status. Questions were also asked about depression anxiety, activity levels, and acceptance of pain levels.
Analysis of the data showed three basic subgroups of behavior. These included avoidance, pacing, and confronting. Avoidance refers to the fact that the patient doesn't do anything that might make the pain worse. Pacing means the patient uses lots of rest breaks in between activities. And confronting was described as not pushing to get things done despite the pain.
The authors were expecting that patients who used pacing would have better function. The results of this study showed quite the opposite. It turned out that pacing had strong elements of avoidance to it. Calling their actions pacing or pain management allowed some patients to actually avoid activities.
They also found that avoidance does lead to lower levels of physical activity and higher levels of anxiety. As might be expected, patients who reported high levels of activity combined with low avoidance behaviors had the best results. Avoiding activity didn’t promote healthy function in chronic pain patients.
The authors suggest several changes in behavioral management programs for chronic pain patients. First, using electronic activity monitors may help provide a better idea of patients' true activity levels. Right now, researchers rely on each patient to remember and report activity level accurately.
Behavior management programs should help patients avoid extreme fluctuations. Going from pacing to avoiding should be replaced with steady rates of activity. This method might help patients become more functional in the long run.
And patients who confront their pain and overdo it may be unwilling to accept real limitations or see the need to change. They need guidance and direction to overcome this pattern. Chronic pain patients should be coached in behavior patterns that provide free and full functioning.
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References:
Lance M. McCracken. The Role of Avoidance, Pacing, and Other Activity Patterns in Chronic Pain. In Pain. July 2007. Vol. 130. No. 1-2. Pp. 119-125.
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