Chair: Tamar Pincus, United Kingdom
Speaker: Emelien Lauwerier, Belgium
Adaptive management of chronic pain depends on a large extent on how patients choose to cope with pain and its impact on a day-to-day basis. Having to live with chronic pain involves dealing with new circumstances that need self-management strategies that often differ from habitual ones. Learning new skills is therefore an integral part of pain treatment. Operant-based treatments, such as graded activity, involve the reinforcement of “adaptive” pain behavior, such as pacing activity, so that functioning despite pain is accomplished and maintained. Cognitive-behavioral therapy involves cognitive restructuring, or learning to use and apply other ways of thinking about their pain, besides a range of other new skills to be learned, such as attention-control techniques, problem- solving skills, and new behavioral patterns through exposure techniques. The extent to which patients adopt and maintain these skills will largely depend on their motivation for making these changes.
The current lecture tackles this important construct and its implications for pain treatment through a number of modules. A first module is introductory and aimed at raising awareness to tackle motivation in pain treatment. A second module reviews a selection of theories on motivation and behavior change, discusses strengths and limitations, and their potential value to understanding the promotion of self-management behavior in pain treatment. A third module tackles one approach that contains strategies to enhance motivation in treatment. We will discuss its basic philosophy, review effectiveness, and apply its principles to the problem of pain. A fourth and last module discusses implications of the motivational approach to pain treatment and a number of recommendations for practice are given, both regarding to (pre-treatment) assessment, as well as with regard to how motivation-enhancement techniques may complement evidence-based pain treatment.