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Psychoeducation for Chronic Pain Patients: Effects and Recommendations

This presentation explores the use of psychoeducation and multidisciplinary interventions for chronic pain patients, examining the positive effects on pain intensity, coping strategies, and overall quality of life. The speaker also discusses challenges and targeting strategies for effective treatment.

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Psychoeducation for Chronic Pain Patients: Effects and Recommendations

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  1. Is it useful for chronic pain patients ? Therapeutic Patient Education (TPE) Psycho-education Cognitive Behavioral Therapy (CBT) Françoise LAROCHE, MD Pain and Rheumatologic Department Saint-Antoine Hospital and University President of the French Rheumatologic Pain Study Group Paris

  2. Disclosure Statement of Financial Interest I, Dr Françoise LarocheDO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

  3. Multidisciplinary interventions and psychoeducation Effects in Chronic Pain 40 studies, 4781 patients (Eccleston C, Cochrane Database 2009) Results : positive but small effects (ES = 0,15- 0,45) pain disability mood

  4. Multidisciplinary interventions and psychoeducation For example Chronic Low Back Pain

  5. Multidisciplinary interventions and psychoeducation Effects in Chronic Low Back Pain Positive effects on : pain intensity cognitive coping behavioral expression of pain health-related quality of life depression Morley S, Pain 1999, Hoffman B, Health Psychol 2007, Lamb S, Lancet 2010

  6. Multidisciplinary interventions and psychoeducationRecommandations - LBP Chou, 2007. Non pharmacologic therapies for acute and chronic low back pain: a review of the evidence for the American Pain Society and American College of Physicians clinical practice guideline European Guidelines for the management of chronic non specific low back pain (COST B13), 2004 Koes, van Tulder, Thomas. Diagnosis and treatment of low back, BMJ 2006 French recommandations of the HAS (haute autorité santé), 2000

  7. Multidisciplinary interventions and psychoeducationRecommandations - LBP secondary prevention back school (biomedical model) : no psycho-education as a biopsychosocial model - multidisciplinary approach adapted to the patient impact ?

  8. Multidisciplinary interventions and psychoeducationMethodological issues • low methodology quality • low number of patients • recruitments bias • patients’ population heterogeneity • care provider competencies • outcome measures • outcome assessment • various control groups • program contents • combination with other interventions Van der Windt, Spine 2008

  9. Multidisciplinary interventions and psychoeducation« What works for whom? - Challenges • Patients selection  Matched intervention to patient’s characteristics • early in the disease • psychosocial yellow flags • patient knowledge • personal locus of control • kinesiophobia  • readiness to change • coping • efficacy expectations • treatment credibility • patient’s preference Vlaeyen and Morley, Clin J Pain 2005 Smeets , Clin J Pain 2008

  10. Multidisciplinary interventions and psychoeducation« What works for whom? » - Challenges • Targeting strategies • The aptitude X treatment interaction framework • Therapist’s skills • Outcome • Pain intensity ? Disability ? Mood ? • Patient Reported Outcomes (PRO) • Patient Global Impression of Change (PGIC) • Satisfaction Vlaeyen and Morley, Clin J Pain 2005 Smeets , Clin J Pain 2008

  11. Psycho-education for chronic pain Our program Intervention : 8 weekly, 2.30 hour session 5 - 8 patients Education, CBT and physical exercises Chronic Low back pain, fibromyalgia Outcome measures: Satisfaction, PGIC, VAS pain, Dallas Pain Q, Hamilton scale, FABQ, Coping Strategy Q

  12. Psycho-education for chronic pain Our objectives increase understanding (pain, LBP, consequences…) decrease fear, catastrophizing and limitations increase health behavior restore function restore interpersonal interactions Smeets, J Pain 2006

  13. Psycho-education for chronic painAn example of misunderstanding…

  14. Psycho-education for chronic pain Our patients Chronic pain outpatients referred for multidisciplinary program Disability Fear of movement Ready to change Available for the 8 sessions Fluency in french

  15. Psycho-education for chronic painExcluded patients • red flags • other painful conditions • substance abuse interfering with treatment • serious psychopathology • litigation’s involvment • not available or motivated • lack of fluency in french

  16. Psycho-education for chronic painTargeting therapy Rehabilitation Avoidance Incapacity Impairment Graded Exposure Coping Fear Lesion Pain Relaxation Cognitive tools Catastrophizing

  17. Psycho-education for chronic pain « The ZERO session » • Objectives : patients’ selection improvement • Intervention modalities : • active participants – agenda, tasks, reading… • learned skills • patients’ and therapists goals - expectations • multimodal intervention Vlaeyen and Morley, Clin J Pain 2005

  18. Psycho-education for chronic pain Operant therapy and Graded activity • Objectives : decrease fear and avoidance • Therapy : • Establishing functional goals • Fear hierarchy • Problem solving • Behavioral experiments Leeuw, Pain in press

  19. Psycho-education for chronic pain Sharing experience and relaxation • Objectives : decrease hypervigilance and anxiety • Therapy : • Beck columns (pain situation  cognitions  emotions  behaviour) • Acceptance • Self efficacy (learned helplessness) • Distraction • Optimism – life objectives Peters, Pain 2005

  20. From research to real life… Building a new paradigm How can we improve our interventions ? • Patient’s selection - catastrophizing • Early interventions • Match interventions to patient - responders

  21. Psychoeducation and chronic pain Vlaeyen J. Cognitive-behavioural treatments for chronic pain: what works for whom? The Clinical Journal of Pain 2005; 21:1-8. Linton S. The effects of CBT and physical preventive interventions on pain related sick leave. Clin J Pain 2005 ; 21: 109-19 Hoffman B. Metaanalysis of psychological interventions for chronic low back pain. Health psychology 2007; 26: 1-19 Van der Windt D. Psychological interventions for low back pain in primary care. Spine 2008; 33: 81-9 Eccleston C. Psychological therapies for the management of chronic pain, Cochrane database of systematic review 2009 Lamb S. CBT groups for LBP in primary care, Lancet 2010

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