The management of chronic pain is a challenge that nurses have to tackle on a daily basis. Many patients suffering from chronic diseases experience pain due to psychological, physical and emotional trauma. According to Park and Moon (2010), chronic pain presents with both physical and psychological symptoms, and it affects a fifth of the population in the developed countries. Various methods have been devised for the management of chronic pain, and advances have been made. However, chronic pain management remains a challenge in the health care settings. Since nurses are the group of the healthcare team that spends most of their time with the patients, it is important they keep up to date with the discovery of new knowledge, through research, to adopt the latest, effective methods of managing pain. Both pharmacological and non-pharmacological methods have been employed in the management of chronic pain, in chronically ill patients. Non-pharmacological methods include psych education and cognitive behavioral therapy. Determining the most effective method among the three is a pivotal milestone in tackling the challenge of chronic pain management in palliative care settings.

Current Practice/Background Information:

The target population for this paper are patients who suffer chronic pain. Park and Moon (2010) argue that both physical and psychological injuries are likely to result to chronic pain. Chronic diseases, like cancer, diabetes and hypertension also predispose the victims to prolonged, chronic pain. Currently, three major techniques are applied in the plan of care for the management of chronic pain. Thomas, Weiss and Sylvester (200) as well as Salvetti (2012) affirm that psych education has been found to be very effective in the management of chronic pain. On the other hand, Halford and Brown (2009) assert that, cognitive behavioral therapy is effective, not only in treating chronic pain, but also in managing mental disease in chronically ill patients. Additionally, Park and Moon (2010) champion for pharmacological management of chronic pain, although this is rooted to a good choice of the pharmacological agents of pain management and a good plan of care. Since the challenge of chronic pain management remains, it is important to champion continuous research in this area, to determine the extent in which the different strategies of management are effective.

Literature Search/ Interventions:

i). Psychoeducation:

Chronic pain does not discriminate against age or type of chronic disease. Whether child or adult, one is very predisposed to chronic pain if one is suffering from a chronic disease. Although with the inclusion of pharmacological interventions, the management of chronic pain depends greatly on the consideration of psychological variables. In this regard, the effective management of chronic patients has a high dependence on psychoeducation. Salvetti et al. (2012) conducted an eight-week study to determine the effectiveness of psychoeducation on chronic management. The researcher involved a total of seventy-nine patients, who had chronic pain of different etiologies. They found out that psychoeducation is effective in reducing depressive symptoms, which is directly related to pain reduction. The method is also effective in reducing disability and decreasing the intensity of pain. According the Thomas, Weiss and Sylvester (2000), psychotherapy is preferred because it empowers patients to participate actively in the pain managements activities. Such activities contribute to the psychological wellness of the patients.

Although there are few studies that have been conducted in relation to psychoeducation, it has been found that patient psychoeducation is a major strategy that can be used to modify the attitudes of patients in regard to chronic pain management (Salvetti et al. 2010). Apart from its direct effect on reducing chronic pain, psychoeducation also contributes greatly in enhancing patient behavior in regard to medications and treatment plans. Many patients suffering from chronic diseases are likely to stop taking medications by the time they feel better. However, psychoeducation supports such patients and one they feel better, they are less likely to stop taking their medications. I addition, psychoeducation promotes personal responsibility in chronic pain management. In essence, thus, patients are able to handle side effects of the medications, as they anticipate them, and can initiate measures to prevent them. Thomas, Weiss and Sylvester (2000) argue that patients undergoing psychoeducation are less likely to worry about addiction and tolerance as compared to the patients under medications alone. Exploring psychoeducation in the management of pain is thus a very beneficial milestone in the management of chronic pain, and thus, treatment of chronically ill patients.

ii). Cognitive Behavioral Therapy:

Cognitive behavioral therapy is a very important theoretical model in the management of chronic pain. Halford and Brown (2009) argue that CBT is based on the thinking that behavior, mood and physical symptoms are very interrelated. Halford and Brown (2009) observe that the patients’ cognitive appraisal of events serves to determine their responses to treatment in CBT. Such observation may explain why CBT has been more directed to groups and individuals, rather than couples and families (Thomas, Weis and Sylvester, 2000). Due to the assumption of the mental, emotional and physical interrelations, the CBT perspective focuses of modifying the feelings, behaviors and thoughts that may lead to emotional and psychological disturbance. The preference of cognitive behavioral therapy, according to Halford and Brown (2009), is its use in, not only treating psychological pain in chronic ill patients, but also addressing negative beliefs, adjustment to illness and illness behaviors.

Cognitive behavioral therapy focuses on supporting chronically ill patients to adjust to illnesses. The process of adjusting to an illness has several hurdles that patients try to negotiate with. According to Halford and Brown (2009), the chronically ill patients negotiate with the management about the future, try to search for meaning in life, try to deal with their loss of control, and their need for medical and emotional support. The psychotherapist thus considers such aspects in the plan of care, and incorporates every aspect in order to realize the effectiveness of cognitive behavioral therapy. A good plan of care that factors all these aspects is likely to be very beneficial to the clients, including promoting their adherence to the overall treatment plan.

iii). Pharmacological management

While using pharmacological agents in the management of chronic pain, Park and Moon (2010) advise that the healthcare providers ought to consider the multifactorial characteristic of chronic pain. These authors argue that chronic pain has both the nociceptive and neuropathic components. A good pharmacological background is thus essential for selecting pharmacological agents in a manner that considers age and the physiological background of the patient. In such considerations, a patient with renal failure will have their dose modified, and so is a geriatric and a pediatric patient. In addition, the application of the muiti-mechanistic approach requires that a patient may be given dugs of different classes, or drugs of the same class but with different mechanisms of action. However, a single drug that has the two properties of relieving both nociceptive and neuropathic pain is preferable. Park and Moon (2010) further reiterate that the health care provider ought to carry out comprehensive assessments to determine the degree of pain, I order to plan how better to manage it. According to Park and Moon (2005), pharmacological management is very essential as a component of care in physical chronic illness. Although medications may not be effective in managing psychological pain as a result of the disease process, these authors argue that the physical component of the pain can be treated successfully using pharmacological agents. Such observation justifies the comprehensive assessment needed in pharmacological management. A limitation of pharmacological method is that it requires a lot of assurance from the physician. The elements of psychotherapy must thus be incorporated to make it more effective.

Search sites and Key Words:

While conducting this search, the researcher used credible academic, medical-content databases such as CINAHL, Medline and MedSpace. Several key words were used to ensure that the writer obtained reliable information in regard to the topic. The search words were pharmacological management of chronic pain, management of chronic pain, non-pharmacological management of chronic pain, pshychoeducation in chronic pain, cognitive behavioral therapy, medical management of chronic and psychotherapy in chronic pain management.

PICOT Question:

Is psychoeducation more effective in the management of pain in chronically ill patients as compared to pharmacological management?

P-Population-Chronically ill Patients

I-Intervention-Psychoeducation

C-Comparison-Pharmacological management

O-Outcome-the result of psychoeducation

T-Time-duration of ailment/treatment

References

Halford, J., & Brown, T. (2009). Cognitive-behavioral therapy as an adjunctive treatment in chronic physical illness. Advances in Psychiatric Treatment, 15(3), 306-317.

Park, J. H., & Moon, E. D. (2005). Pharmacologic management of chronic pain. Korean Journal of Pain, 23(2), 98-108.

Thomas, M. E., Weiss, M. S., & Sylvester, S. (200). Non-pharmacological interventions with chronic cancer pain in adults. Cancer Control, 7(2).

Saveltti, G. M., Cobelo, A., Vernalha, P. D., Vianna, I. C., Canarezi, C. L., &Calegare, G. R. (2012). Effects of psychoeducational program for chronic pain management. Rev LatAm Enfermagem, 20(5), 896-902.

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