What are the approaches to patient-centered care for pain management?

From the Guidelines

Patient-centered care for pain management should prioritize a holistic, multimodal approach that involves a comprehensive interdisciplinary team, focusing on individualized care based on each patient's unique needs, preferences, and goals. This approach is supported by the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1, which recommends a comprehensive approach including patient education, physical therapy, occupational therapy, and behavioral therapy.

Key Components of Patient-Centered Care

• Patient education on the neurophysiology of pain to improve pain management and understanding of treatment goals 1
• Physical therapy to address the multifactorial nature of pain syndromes
• Occupational therapy to improve functional abilities
• Behavioral therapy to address psychological components of pain
• Regular assessments to track progress, adjust treatment, and identify any treatment-related adverse events or behaviors 1

Personalized Management Plan

A personalized management plan should be guided by shared decision-making, the expressed needs of the patient, the health professional’s assessment, and evidence-based treatment options, as recommended by the 2018 EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis 1. This plan may include a stepped-care approach, with education and self-management support as the first step, followed by specialist treatment options and multidisciplinary treatment as needed.

Non-Pharmacological Approaches

Non-pharmacological approaches, such as cognitive behavioral therapy, mindfulness meditation, heat/cold therapy, and regular exercise, are equally important in pain management and should be tailored to the patient's specific pain condition. Patient education about pain mechanisms, realistic expectations, and self-management strategies is crucial for effective pain management 1.

Regular Assessment and Reevaluation

Regular assessment using validated pain scales and functional measures helps track progress and adjust treatment, ensuring that the patient's unique needs and goals are being met 1. If a new painful symptom arises, healthcare providers should determine whether it is related to worsening of current pathology, development of new pathology, failure of current analgesic, or an intercurrent event in the patient’s life that has interfered with their ability to self-manage pain 1.

From the FDA Drug Label

When managing patients taking opioid analgesics, particularly those who have been treated for a long duration and/or with high doses for chronic pain, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper A multimodal approach to pain management may optimize the treatment of chronic pain, as well as assist with the successful tapering of the opioid analgesic In patients taking opioids for a long duration at high doses, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper

The approaches to patient-centered care for pain management include:

• Multimodal approach to pain management
• Mental health support (if needed)
• Patient-specific plan to taper the dose of the opioid gradually
• Frequent reassessment of the patient to manage pain and withdrawal symptoms 2 2

From the Research

Approaches to Patient-Centered Care for Pain Management

• Comprehensive pain assessment is a critical step in the initial development of a pain management plan and for ongoing evaluation of patients' pain 3, 4
• Use of a multidimensional tool is recommended for assessing many features of pain, including pain qualities, duration, impact on functional capabilities, and underlying cause 3
• Patient age, sex, psychosocial features, and comorbid conditions are also important features to consider in pain management 3
• A "universal precautions" approach including abuse risk assessment and abuse deterrence strategies should be implemented for patients receiving opioids 3

Patient-Centered Pain Management Strategies

• Patient-centered teaching about medications can help address concerns and fears surrounding medication use, particularly with narcotic analgesics 4
• Validation of patients' concerns, followed by education, can be an effective approach in pain management 4
• Use of comprehensive pain assessment tools, such as the Clinically Aligned Pain Assessment (CAPA) tool, can lead to more effective treatments for pain and improved patient outcomes 5

Comprehensive Pain Management Programs

• Comprehensive pain recovery programs, which consist of providers from multiple backgrounds, can treat pain on an individual level through a combination of approaches, including physical therapy, emotional and spiritual support, cognitive behavioral therapy, and non-opioid pharmacotherapies 6
• These programs can reduce pain severity and improve functioning, and can be used to treat those with post-surgical pain and chronic pain 6

Patient and Provider Perspectives on Patient-Centered Pain Management

• Patients with chronic pain emphasize the importance of a provider who listens, genuinely cares, and sees them holistically to provide the best individual and tailored care 7
• Providers focus on setting realistic expectations, vocalizing the significance of pain education, and balancing patient satisfaction and opioid prescriptions 7
• Patient-centered pain management can empower patients to self-manage their chronic pain, but provider mental exhaustion and mistrust of providers among patients can result from suboptimal pain management 7