By Guillaume Christe
Self-management strategies play a key role in many chronic illnesses. In the case of back pain, self-management interventions are strongly recommended for both acute and chronic conditions. These strategies are particularly important to implement, as back pain is an ongoing condition, often with recurring episodes. Supported self-management – when a patient performs tasks aimed at managing symptoms and their interference in activities, mood, and relationships due to pain – is also promoted by our current understanding of back pain. Back pain is understood as a multidimensional condition, in which many factors that can be changed by supported self-management have a role.
The International Association for the Study of Pain offered a series of webinars as part of the 2021 Global Year About Back Pain. One such webinar was “Supported Back Pain Self-Management – Made Simple.” This webinar aimed to provide simple strategies for healthcare professionals and people with back pain to facilitate the implementation of supported self-management. The webinar included four presenters: Pete Moore, Katie Knapton, Bronwyn Lennox Thompson, MSc, PhD, and Toby Newton-John, PhD.
Pete Moore is a person living with pain, a pain self-management trainer, coach, author, and the creator of the Pain Toolkit in the UK. The Pain Toolkit provides tips and skills to self-manage persistent pain. Katie Knapton, a chartered physiotherapist, is the CEO and founder of PhysioFast Online, an online physiotherapy clinic, which is also located in the UK. Bronwyn Lennox Thompson is a clinical senior lecturer at the University of Otago, Christchurch, New Zealand. Toby Newton-John is the deputy head of School Research, the Graduate School of Health, at the University of Technology, Sydney, Australia. The webinar was moderated by Trevor Barker, a pain coach for Amelio Health in Australia, who offers pain management programs.
A recording of the webinar is freely available here.
What is supported self-management?
While acknowledging there is no general agreement, the definition for the supported self-management of chronic pain was proposed as when a “patient performs tasks aimed at managing symptoms and their interference in activities, mood, and relationships due to pain.” This definition highlights that the patient, and not the healthcare professional, has the main role. It is not about curing or treating chronic pain, but managing symptoms and how they interfere with that person’s life. Supported self-management of chronic pain involves a wide range of components and can be delivered in multiple ways, the gold standard being a multidisciplinary, group-based cognitive-behavioral pain management program.
Strategies to improve supported self-management
To improve the effects of supported self-management strategies, three important shifts from traditional care are needed. First, supported self-management should embrace personalized care and involve a “power shift,” where the person living with chronic pain is recognized as their own expert. Second, there should be a “responsibility shift” that integrates a person living with chronic pain and multiple healthcare organizations, which take a collective responsibility to support them. Third, there needs to be an “expectation shift,” which means the healthcare system should provide management strategies for long-term conditions, and not just for single events.
Key principles of supported self-management and clinical tips were provided to support its implementation into practice and are described hereafter.
Individualized care and the importance of context
Supported self-management encompasses a person-centered approach that is organized around that person’s needs and preferences. It acknowledges the importance of multiple factors of chronic pain, such as emotions, beliefs, coping strategies, and physical health, to name a few. Furthermore, the context of the person, such as their values and activities, are key to developing individualized supported self-management strategies and should be explored during the assessment. Supported self-management strategies should include behavioral changes in the person’s context, and these should be tailored to their preferences. Experimentation of new behavior in the person’s context is thought to foster the generalization of new learning. Finally, the person’s learning preferences are important to consider when delivering supported self-management.
Clinical encounter, therapeutic alliance, and motivational interviewing
Different strategies related to clinical encounters to improve supported self-management were discussed during the webinar. Motivational interviewing, a person-centered form of guiding to elicit and strengthen motivation for change, and its principles, are known to facilitate behavioral changes. Using motivational interviewing, the healthcare professional will avoid acting as the only expert and instead elicit the person’s thoughts and expertise through questioning, reflect on the person’s responses, and ask permission to share ideas.
This approach through motivational interviewing is a better way to facilitate changes in both beliefs and behavior. Helping people to realize that there are multiple ways to achieve their goals can be a useful strategy. The importance of active listening – allowing the person to express their needs, thoughts, and feelings – is key to this type of clinical encounter. People living with chronic pain should feel understood and believed. Healthcare professionals are encouraged to use simple language and avoid nocebo terms (terms that can create negative expectations, which can cause negative effects), as one important goal of supported self-management is to help people make sense of what they are currently experiencing.
Key strategies for supported self-management
A range of helpful supported self-management strategies for people living with back pain were offered during the webinar. They consisted of:
Goal setting: Allow the person to express their unique needs and preferences and facilitate shared decision-making.
Pacing daily activities: Help people living with chronic pain reduce the interference of pain in their daily activities, which may help them do more in one day. This strategy implies pausing activities before the pain starts or worsens. For instance, if pain starts or worsens after 10 minutes of walking, it may help to stop after five minutes. It will be easier to take several five-minute walks per day as opposed to a single 10-minute walk.
Problem-solving skills: Help people find their own solutions.
Keeping active: It can be difficult with back pain but finding strategies to maintain physical activity, exercises, and meaningful engagement can be very helpful.
Have a setback plan: Back pain is an ongoing condition with recurring episodes. Supporting people with back pain should include strategies on how to deal with new episodes of back pain or other life events that worsen their situation.
Teamwork: Building a support network can be advantageous for patients. For clinicians, recognize your own limitations, and work with other professionals as a team.
In the case of back pain, supported self-management should be one of the first treatment options. This webinar highlighted key principles of supported self-management, including personalized care, shared responsibility and expertise, empowerment, and long-term processes. The strategies and clinical tips discussed in this webinar should help to integrate supported self-management into clinical practice.
Guillaume Christe is a physiotherapist, PhD candidate, and PRF correspondent at the Swiss BioMotion Lab, and a lecturer at HESAV, Lausanne, Switzerland.