In my recent research, I came across an interesting article on the efficacy of CBT for various psychosocial conditions as well as other conditions. Hofmann et al. found inconclusive evidence for CBT chronic pain management. Interestingly, the CDC also recommending alternatives to pharmacological methods for chronic pain including CBT, exercise therapy, intervention treatments, and multimodal pain treatments.
This is a step in the right direction as America is having an opioid epidemic. My wife who is a nurse sees this every day with patients who come and go, only to come back asking for more pain medication. While they are being seen by OT and PT, in my opinion, more needs to be done to address their chronic pain.
Even if the evidence for say, CBT is inconclusive, the team should take an interdisciplinary approach and offer different strategies and interventions besides medications. Interdisciplinary treatment has demonstrated effectiveness in reducing pain severity, improving mood, and restoring function (Gatchel & Okifuji, 2006; Morley, Eccleston, & Williams, 1999; Oslund et al., 2009).
However, I am guilty of this myself when working with patients such as on ortho – “Hi nurse, have they been pre-medicated?” While medications can and do help a lot and have a place in rehab, OTs should be getting creative and integrating different interventions based on research such as Lifestyle Redesign®.
Effectiveness of Lifestyle Redesign®
Simon & Collins observed in a retrospective study that Lifestyle Redesign® demonstrated improvement in COPM scores, 36-Item Short-Form Survey, Brief Pain Inventory, and Pain Self-Efficacy Questionnaire with a sample of 45 patients in an outpatient setting. What was nice was that some patients participated in physical therapy, psychotherapy, or both.
Lifestyle Redesign® focuses on client education, self-analysis, problem solving, motivation building, and implementation of desired behaviors. Habits and routines are addressed as well as how the client manages their time. The areas address were quite comprehensive and included:
- Self-care (Routines, choices, adherence)
- Energy and fatigue management
- Time management
- Health management
- Body mechanics and posture
- Community integration (IADLs, Socialization, Work)
- More specific pain management topics, e.g. “flare-ups”
Many aspects of Lifestyle Redesign® can be borrowed from and used for pain management with clients. Ideally, the OT would be trained in Lifestyle Redesign® from USC to provide intervention for pain. The multidisciplinary, multi-occupation and comprehensive nature of this intervention is probably what makes it so successful. In particular, the pain topics help to educate clients for how manage their pain as well. Learning to communicate pain with healthcare providers allows them to advocate for themselves and improve their quality of life. In an outpatient setting, it is especially important to address all the client’s relevant occupations and how they may manage their pain in each situation. By taking a holistic approach and modifying a client’s habits and routines, they are more likely to be successful with managing their pain symptoms, improving their mood, and participating fully in the occupations that are realistic to them.
Gatchel, R. J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. Journal of Pain, 7, 779–793. https://doi.org/ 10.1016/j.jpain.2006.08.005
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.
Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80, 1–13. https://doi.org/10.1016/S0304-3959 (98)00255-3
Oslund, S., Robinson, R. C., Clark, T. C., Garofalo, J. P., Behnk, P., Walker, B., . . . Noe, C. E. (2009). Long-term effectiveness of a comprehensive pain management program: Strengthening the case for interdisciplinary care. Baylor University Medical Center Proceedings, 22, 211–214.
Simon, A. U., & Collins, C. E. (2017). Lifestyle Redesign® for chronic pain management: A retrospective clinical efficacy study. American Journal of Occupational Therapy, 71(4), 7104190040p1-7104190040p7.