This article is part of a series that will bring the latest developments in nursing science from the National Institute of Nursing Research to practicing nurses.
Pain affects about nine in ten Americans—more than diabetes, heart disease, and cancer combined. Chronic pain, defined as pain persisting for months or extending beyond a normal healing period, can interfere with daily activities and sleep. It’s the most common cause of long-term disability.
Pain self-management programs, which encourage patients to participate actively in their treatment plan, can improve how we address chronic pain. Studies show that patients involved in such programs can cope better with pain, report fewer negative responses to pain, and demonstrate better overall management of their painful conditions. Research supported by the National Institute of Nursing Research (NINR) is exploring several such programs for patients with chronic pain related to fibromyalgia, cancer, and conditions associated with aging.
A debilitating syndrome primarily affecting women, fibromyalgia is marked by localized and widespread muscle and joint pain, sleep disruption, and fatigue. It can cause difficulty exercising, which in turn may lead to muscle deconditioning that exacerbates pain. About one-third of fibromyalgia patients have low levels of certain growth factors, which may predispose them to exercise-induced muscle microtrauma.
Previous studies indicated that when combined with exercise, the drug pyridostigmine increases growth-factor release. A clinical study evaluated women who’d received this drug either alone or in combination with a supervised exercise program. Although the subjects didn’t report a decrease in fibromyalgia pain, pyridostigmine did contribute to improved sleep and decreased anxiety, while exercise led to better fitness and reduced fatigue. These findings suggest that a combined program of medication and exercise may address multiple fibromyalgia symptoms.
Although pain is a common cancer symptom, a nurse scientist working with cancer patients noticed many of them underused pain medications out of concern about adverse effects or addiction, even when pain impaired their quality of life. This observation led to development of RIDcancerPain, an individualized educational program focusing on helping cancer patients understand their perceptions of pain and its causes as well as the benefits of prescribed pain medications.
In one study, patients in the RIDcancerPain program reported a decrease in their usual pain level and a more positive attitude toward analgesic use compared to patients who received an informational pamphlet on pain. The program didn’t eliminate cancer pain but did reduce some of the barriers patients identified in managing pain. (For more information on RIDcancerPain, contact Dr. Sandra Ward at firstname.lastname@example.org.)
Pain and aging
Pain from osteoarthritis or other long-term health conditions is a common problem of aging and can be debilitating. One research team tested a self-management intervention among a group of elderly adults with diverse chronic pain conditions that limited their daily activities. The intervention consisted of group educational sessions on the basic principles of pain, followed by training in exercise, muscle relaxation, activity pacing, positive thinking, and proper use of pain medications and complementary therapies. Each participant chose which strategies to include in a personalized pain-management plan. In contrast, participants in a control group received a chronic pain workbook that included current information on pain and self-management strategies.
At 1-year follow-up, neither the intervention nor the control group reported reduced levels of overall pain, pain medication use, or depression. However, intervention participants increased their use of relaxation techniques, exercise, and stretching to cope with pain. Also, about one-fourth of participants in both groups reported a significant improvement in test scores on pain-related physical disability. Taken together, these findings point to the potential usefulness of various educational strategies to help seniors manage chronic pain, as well as the benefits of active participation in addressing complex issues surrounding pain symptoms.
Journey to better pain management
Ongoing research promises to promote better outcomes for those with chronic pain. Scientists in the NINR Intramural Research Program are examining genetic factors related to pain medications and pain sensitivity in the hope of discovering new pain-management approaches. New symptom-management strategies under development examine combinations of biological and behavioral therapies, adaptable to individual patients’ needs. Further explorations will seek to identify and treat pain at its earliest stages to preempt the development of chronic pain. NINR-supported research will continue to advance our understanding of pain and its management, toward the goal of decreasing its impact and improving the quality of life for pain sufferers across disease conditions.
Ersek M, Turner JA, Cain KC, Kemp CA. Results of a randomized controlled trial to examine the efficacy of a chronic pain self-management group for older adults. Pain. 2008;138:29-40.
Jones KD, Burckhardt CS, Deodhar AA, Perrin NA, Hanson GC, Bennet, RM. A six-month randomized controlled trial of exercise and pyridostigmine in the treatment of fibromyalgia. Arthritis Rheum. 2008;58(2):612-622.
National Institutes of Health. Fact sheet: Pain management. www.nih.gov/about/researchresultsforthepublic/Pain.pdf. Accessed April 20, 2009.
Ward S, Gunnarsdottir S, Shapiro GR, Donovan H, Serlin RC, Hughes S. A randomized trial of a representation intervention to decrease cancer pain (RIDcancerPain). Health Psychol. 2008;27(1):59-67.
Woodcock J, Witter J, Dionne RA. Stimulating the development of mechanism-based, individualized pain therapies. Nat Rev Drug Discov. 2007;6(9):703-710.