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Education, information and a cognitive behavioural approach to pain management

Posted Feb 23 2009 10:41pm

For over 10 years now, I’ve winced every time someone has suggested that I’m ‘teaching’ when I facilitate pain management groups.  Something about the word ‘teach’ gives me the heebie-jeebies - and I have nothing against teachers!

I think it’s the flavour of me being some sort of ‘expert’ giving information or education to others.  I resist it as much as I can!

Using a cognitive behavioural approach seems to me, at least, to be something different from ‘teaching’, or ‘informing’.  So over the next few days I want to wander through some of the distinctions that I feel, and at least clarify it to myself!

The basic tenets of a cognitive behavioural approach to chronic pain management are that

  • That clients can learn to accept the chronicity of their pain.
  • That clients can change their relationship to their pain in a way that allows them to broaden their sense of identity/self beyond the pain to that of “a well person with pain”.
  • That clients can learn or re-explore skills to deal more effectively with their pain, e.g., relaxation training, activity-rest cycling, graded exercise, attention management. (Morley, Biggs & Shapiro)

While information and education form part of this process, simply providing information and education alone (whether ‘deep’ education or not) doesn’t necessarily make for changed behaviour - and behaviours are the target of a cognitive behavioural approach.  It helps for thoughts and beliefs to change also, but not always essential.

I think I explore concepts with people rather than ‘teach’ them.  I hope my approach is more about leading people through a process of discovery rather than presenting them with ‘facts’ that are either true or not true.  While I do discuss a model of pain, and refer to things like the gate control, the neuromatrix and central sensitisation, I think it’s more about helping the person develop their own model of pain based on experimenting with the various hypotheses that we develop together.

I guess one reason I avoid using the word ‘teach’ and the concept of ‘education’ is that this often puts the person who has pain in a relatively passive position of either accepting the teaching, or not.  And given that our models of pain evolve over time, and therefore are more or less representative of ‘truth’ (and that everyone’s pain is influenced slightly differently by different factors), it seems important to offer these models as a way of hanging ideas together rather than what really happens.

The following strategies can be used to help people reconceptualise their pain  - and yes, some are used in adult education.

  1. Socratic questioning
  2. Behavioural experiments  - (the link will take you to an example of a BE)
  3. Cognitive continuum
  4. Role plays (rational-emotive)
  5. Using others as a reference point
  6. Acting ‘as if’
  7. Self-disclosure (Beck, 1995, p 152)

These processes move beyond ‘informing’ and ‘educating’ because they invite the person to really engage with, and reflect on their own beliefs in the light of new information.   The behavioural components especially involve the person being engaged with new material, and working to evaluate the usefulness of new behaviours to achieve personal goals.

I’ll keep on mulling this over this week, as I explore the idea of ‘education’ and pain management.

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