Self-management approaches are intended to integrate with and enhance regular medical treatment. Self-management training provides the patient with skills to coordinate tasks needed to manage their pain, as well as to help them keep active in their day-to-day lives. Self-management training can also help foster a more effective collaboration between patient and provider. It increases the chances that patients will discuss the things they do to manage their pain on their own with their medical providers.

The primary objectives of self-management programs are to provide patients with information and skills that enhance their ability to participate in their health care (e.g., communicate with providers, identify relevant information, and adhere to treatment). Patients need support and guidance to help them master the skills required to minimize pain flares, while optimizing mood and functioning. Specific skills based on a cognitive behavioral model offer excellent utility in meeting those needs. These skills include:

• The ability to interpret changes in pain in a meaningful way
• Engagement in pain reducing and health-promoting behaviors
• Development of action plans for anticipating and coping with pain exacerbations.

A central element in a pain self-management approach is to help patients understand the toll that living with pain has taken on their emotions, daily activities, and relationships. Many self-management techniques can alter the subjective experience of pain and the psychosocial influences on pain. Beliefs about pain, fears of harm, avoidance responses, ideas about the origins of pain, and expectations of treatment, self-efficacy, and coping, are some of the factors that influence behavioral responses to pain. All of these are important targets of psychosocially oriented self-management approaches. Three of the most important psychological targets for self management intervention are:

• Anxiety and Fear - are common in people with chronic pain so it is essential that patients receive adequate information to allay fears and reduce psychological distress
• Pain Catastrophizing - a pattern of negative thoughts about actual or anticipated pain, including rumination, magnification, and helplessness
• Environmental Factors - play a large role in the direct and indirect reinforcement of pain behavior, and patients need help to recognize if they are getting a secondary gain for their pain behavior

Health literacy is an important component of a comprehensive self-management approach. A person’s capacity to seek, understand and utilize health information to make decisions about their health is an important determinant of how much they can participate in their care. When patients know when to seek medical help, how to effectively communicate with their providers, what they need to do to adhere to treatment, and how to make use of other health services and supports, they are then able to self-manage their pain to a much higher degree. Self-management includes teaching patients how to set goals, assess progress, and solve problems on their own. If these are skills you don’t have time to address with your patients (or more importantly teach), refer patients to a well trained behavioral health provider who has knowledge about pain and pain management. Many medical providers are unaware of the availability and efficacy of behavioral adjuncts to treating pain and promoting patient engagement in pain self-management practices.

Both pain outcomes, and the patient-provider partnership, can be enhanced when self-management training includes the following:

• Behavioral skills with demonstrated efficacy in mediating outcomes
• Education about the environmental and psychological factors that directly and indirectly influence the maintenance of pain behavior and symptoms
• Tools for patients to collect, organize, and reliably report meaningful clinical data to their providers
• Reinforcement of the idea of patient responsibility in the context of a collaborative approach to maintaining health and managing pain.

If you want to help your patients engage in self-management and get the most out of their efforts, your self-management training approach should:

• Be personalized - tasks should be unique for each patient depending on symptoms, personal characteristics, lifestyle, and progress over time
• Address emotional coping issues - emotions can affect the perception of pain; negative emotions are common in those with chronic pain
• Emphasize an active role - set the expectation that your patient is a partner in managing their condition within the context of the patient-provider partnership
• Build confidence and skill - use knowledge in the service of building skills and activating patient participation
• Consider cultural issues - health behavior is connected with culture, so effective self-management messages need to be attuned to the relevant cultural issues.

Another way to help patients become better pain self-managers is to gather your own “evidence” about patient self-management. Ask your current patients who are “successful self-managers” what they needed to know at the beginning, what problems they frequently encountered, and what they still want to know now. Then use this information to fine tune the self-management approach you use with your patients.

If your pain management work takes place in a multi-disciplinary context or team, it is very important to coordinate and be consistent about the self-management messages that are provided by medical, nursing, behavioral, and other health personnel. This helps avoid sending mixed or confusing messages to the patient.

In summary, the coordination and integration of self-management initiatives into patient care offers the potential to enhance the patient–provider relationship and improve outcomes. Addressing key psychosocial targets via self-management skills training can help patients with chronic pain develop an improved ability to confidently manage pain and pain symptoms. It can help them to lead more healthy and active lives, as it promotes greater self-efficacy and well-being.