EDUCATION INTERVENTIONS IN PRIMARY CARE TO IMPROVE CHRONIC PAIN OUTCOMES

Kathleen E. Rogers, Pamela Aselton, Gabrielle Abelard and UMass Amherst. 1. DNP, FNP, MSN. 2. PhD, MPH, FNP-BC. 3. PMHCNS, BC. 4. UMass Amherst, College of Nursing. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


(1), 1270-1274
Review of the Literature:-Reports were sought by searching MEDLINE, psycLIT, CINAHL, EMBASE, NIH, Cochrane, and EBSCO using search terms non-cancer chronic pain, chronic low back pain, and chronic pain. A review of current research in the treatment of chronic pain suggests that health professionals traditionally focus on biomedical views of pain, using pharmacology first, and may not address potential non-pharmacological approaches, such as education to change attitudes towards pain (Rosenblum, Marsh, Joseph, & Portenoy, 2008).
Interventions teaching patients cognitive and behavioral skills, through nursing interventions, are related to overall patient improvement (Stevens, 2013). Research in non-cancer chronic pain management indicates that there is a need for further implementation of health promotion. Interventions teaching patients cognitive and behavioral skills, with pain modifying interventions, are related to overall patient improvement.
Chronic pain management practices vary in clinical practice and are complicated by provider knowledge gaps, time restrictions, lack of patient coping skills and self-management tools, inconsistencies in health education as well as problems of long term opioid use and dependence (Armijo-Olivio, Stiles, Hagen, Biondo, & Cummings, 2012). Evidence suggests that the management of chronic pain in primary care fluctuates and that education with selfmanagement interventions offer improvements in overall care (Williams, 2016).
Non-pharmacological interventions offer an approach to improve patient's quality of life through ongoing education. Patients suffering from chronic pain may undergo long periods of treatment, experience changes in their lifestyle and difficulty with the medications used to manage pain (Lalonde et al., 2015). Offering optimal health promotion to manage chronic pain empowers the patient to engage in self-care activities that result in improvement in individual experiences.
Over 100 million adults in the United States have chronic pain and are impacted with limitations in life, and functional status (Kroenke et al., 2013). The average cost of healthcare, due to chronic pain, ranges over $300 billion. Lost productivity estimates that the total financial burden in the US population at over $600 billion (Gaskin, 2011). Improving chronic pain outcomes and accurately identifying pain intensity are important factors in the development of outcome measures regarding pain reduction (Bauer, Thielke, Katon, Unutzer, & Arean, 2014). Chronic pain constitutes challenges in the absence of an effective cure; strong communication and collaboration between the client and provider can improve functional capacities and quality of life (Brevivik, Collett, Ventafridda, Cohen, & Gallagher, 2006). Psychological factors in chronic pain treatment such as coping skills, quality of life issues, and disability status are important factors that may be addressed. A strong association between chronic pain and psychopathology indicates pain may be associated with depressive or anxiety disorders, substance abuse, and personality disorders. Psychological and social factors are related to the perception of pain, particularly as pain becomes more chronic. In the maintenance of pain behavior and support, clinicians should include cognitive behavioral therapy (CBT) referral for the patient (Ware, Bruckenthal, Davis, & O'Connor-Von, 2011).
Management of chronic pain, with effective treatment modalities and alternatives to opioid medications, involves a comprehensive process in lowering pain intensity (Bueno & Pina, 2008). Alternative modalities can have significant impact on pain outcomes and studies have shown interventions for chronic pain management include health coaching education (Anderson & Taylor, 2011). Further evaluation and education is necessary to improve client outcomes and empower patients' abilities to succeed at modifying chronic pain and improving self-care (Turk, Wilson, & Swanson, 2011) Chronic Pain Management:-Collaborative partnerships with patients and their families through integration of health education and selfmanagement tools incorporating interventions that facilitate pain management focused on complementary alternative medicine methods may assist in managing chronic pain. Posture demonstrations, complementary treatment modality education, stretching and breathing exercises, with additional information regarding the importance of sleep, nutrition, and exercise are helpful for patients with chronic pain. A summary of evidence-based health education focusing on ergonomics, healthy lifestyle behavior, and pain self-care management strategies is presented in Table I. By defining interventions that improve the functional status of the patient, this augments a patient's quality of life and empowers both the patient and the provider to tailor a patient-centered pain management approach. Patient dissatisfaction supports the requisite for improved pain management and the importance of educating individuals to discuss their pain with providers (Schlaeger et al., 2017).

Implementation of Evidence into Practice:-
This review supports the need for pain management interventions in the treatment of chronic pain. Undertreated chronic pain impacts life quality and increases healthcare costs.
Increasing provider and patient education, changes in public policy, and enhancements in pain management support standardization of approaches in the evaluation and treatment of chronic pain in primary care.