Nonpharmacologic Treatment of Chronic Pain—A Critical Domains Approach

For Lisa and many other chronic pain patients, the symptom flares seem to coincide with periods of stress. These flare ups are not inconsequential and have cost her days of lost productivity and potentially put her employment at risk. Moreover, she has identified stress as a trigger for over-eating which certainly contributes to her weight problems and low self-esteem. MBSR can be learned in a structured class or online--many of the principles can be taught by lay instructors.

Summary

While it is likely that health care professionals will continue to rely on pharmacological therapies in treating chronic pain, it is important to be aware that reliance on medications and procedural interventions alone is unlikely to bring adequate relief to individuals living with chronic pain [1]. Optimal pain management appears to be achieved by using a combination of both pharmacologic and nonpharmacologic approaches. Nonpharmacologic interventions that actively engage the patient in pain management such as exercise, behavioral activation, sleep hygiene and stress management are relatively easy to implement and do not necessarily require the expertise of mental health professionals. The challenge is considering pain in its biopsychosocial contexts and defining an approach that is both comprehensive and feasible. Using the ExPRESS domains to help guide care can provide a road map.

Corresponding author: Afton L. Hassett, PsyD, 24 Frank Lloyd Wright Drive, Lobby M, CPFRC, Ann Arbor, MI 48106, afton@med.umich.edu.