Changing the way patients think about pain

[AJ Lievre]

Have a read. How can you change the way your patients think about pain. Have you tried? Has it been successful or has it crashed and burned?
Check out an interesting questionnaire developed by Peter O’Sullivan and co.

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[helenrshep]

I like the idea of using this questionnaire to start the conversation about pain. I often find it challenging to figure out how to bring up pain science stuff, or where best to insert it in conversation. If patients filled this out in their eval paperwork, we could open the door day 1 to talk through it which would in turn lead to pain science talks. I also like that we could use the questionnaire to see how effective we are with our education – hopefully the score improves as we talk through pain science things with the patient.

I have SUCH a hard time trying to change the way patients think about pain. I feel like people usually get defensive or think what I’m talking about doesn’t apply to them. The “Assessing beliefs..” article makes an interesting point – it is harder to elicit positive metacognitions, therefore, we should target negative metacognitions first to help the patient develop meta-cognitive awareness in order to then be open to positive beliefs about worry/rumination. Gives us a good starting point on what order of operations to address metacognitions. I think a big challenge is when people think they are doing the right thing by worrying or analyzing their pain (thinking it is helpful to get out of pain and will avoid future “damage”) and then we try to tell them to do less of that… It’s hard to think that we don’t make them more worried by telling them not to worry – it’s like “think about anything except the elephant in the room” and all you can do is think about the one thing you aren’t supposed to be thinking about. I think the part of the “metacognition, perseverative thinking..” article that says “equipping people with chronic pain skills to attenuate perseverative thinking might be one way to reduce their pain catastrophizing” and “explicitly addressing unhelpful metacognitions through Socratic dialogue and behavioral experiments” is really great, except I’m not quite sure what that looks like in practice.

[awilson12]

Moral of the story- thoughts about thinking about your pain makes you think more about your pain which makes you think more about how bad your pain is which makes you have more pain which makes you continue to think thoughts about your pain…

On a more serious note, though, reading these articles and learning more about pain metacognition was pretty cool. I can’t say I have really thought much about this before and definitely haven’t thought about the differentiation of positive and negative metacognition.

Recently I have had some tricky patients that fit into the patterns these studies talk about. I have tried to incorporate more reflective questioning to get insight to their thoughts on pain and also try and open up a doorway for further discussion. I have about a 500 record with this and have found that continuing to change my questioning and explanation until it is something they really relate to and understand, and then just harping on that.

This tool, although mentioned that it is not yet been tested to determine outcomes of MCT, is something that I could use to understand to a greater degree their thoughts and biases and begin to “break down” their misconceptions.

[lacarroll]

I think this questionnaire uses plain, but descriptive language to frame the patient’s perspective of their pain and of their thinking about their pain. I think that the use of the positive/negative metacognitions is a great way for us to be more aware of where that patient is on the spectrum of awareness and mindfulness of their pain and how that can help us treat the patient more effectively. I agree with Helen that identifying and addressing unhelpful metacognitions sounds like a great place to start, but I’m also not quite sure what that looks like in the clinic, other than pain science education.

I feel like I currently have a few patients that demonstrate the “hypervigilance” and “cognitive intrusion” regarding their pain, and I think that my words aren’t quite to the crash and burn level, but they aren’t super wonderful yet either. It’s like Anna said, I feel like I am constantly trying to think of new phrases to use or how I can word things differently to make the patient get a better picture of what I’m trying (sometimes successfully) to convey.

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