The Pain Explanation and Treatment Diagram: A Tool to Enhance Patient Self-Management of Persistent Pain

Abstract

Patients with persistent pain who are educated about ways to manage their pain have been shown to have fewer pain symptoms [1]; enhanced self-efficacy [1-3], including communication with physicians [4]; and enhanced pain beliefs [3]. Some researchers have discussed the provision of educational materials and multidisciplinary pain education programs to improve self-efficacy and pain-related outcomes [1,5-8]. Brief office-based tools are required to promote self-management of persistent pain. To obtain maximum benefit, patients must be able to recall the diagnostic and treatment information provided to them in the outpatient clinic. However, typically, patients remember limited amounts of information provided during a medical encounter, even in areas as critical as their cancer treatment [9]. In a systematic review, van der Meulen et al [10] found that the use of a question prompt sheet (a structured list of questions designed to encourage patients with cancer to acquire information during a medical consultation [11]) helped to improve recall. However, none of the articles that the authors reviewed discussed the use of a specific, formatted diagnosis and treatment explanation sheet that patients could take home and review at their leisure. Over a 10-year period, the primary researcher (H.M.F.) developed and refined a 1-page tool, the Pain Explanation and Treatment Diagram (PETD) (Figure 1), for use by patients in self-managing their persistent pain. We searched the English-language literature by using the keywords “pain management,” “tools,” and “patient education,” and did not find any articles that described a similar clinician-initiated, office-based educational tool [12]. After taking a history, performing a physical assessment, and reviewing the laboratory data and imaging reports, the clinician completes the PETD with the patient to ensure that he or she understands each section. The PETD incorporates the concept of “pain risk factors,” defined as social, psychological, and lifestyle issues that are perceived to predispose, cause, perturbate, or exacerbate various painful musculoskeletal conditions, such as back or neck pain and fibromyalgia syndrome [13-15]. There is a central diagnosis section in which the problem(s) in general is identified and other problems can be ruled out. Areas reviewed are ergonomics (the machine-human interface; eg, abnormal or unusual body positions assumed during work), exercise (too much or too little and the consequences of either), sleep (inadequate sleep associated with pain can affect mood and impede recovery), and habits (eg, smoking, alcoholism, poor diet). Factors that contribute to the patient’s pain are noted in the appropriate area, and the treatment advised for each problem is specified. Finally, there is a section that elicits any psychological and/or social issues that can affect or aggravate a painful condition, such as stress or a history of physical or sexual abuse, along with a short explanation of how these mind-body interactions arise [14]. On average, it takes 10 minutes to review and complete the form. The patients are instructed to take the PETD home and to place it in a location where it can be viewed repeatedly. They are encouraged to reflect on the relevance of each problem and incorporate the recommended treatments into their regimen. Ideally, patients make connections between social, psychological, and/or lifestyle issues and their pain experience, which enables them to develop their own strategies to help decrease and/or cope with their pain and the factors that contribute to it. Usually the patients return to the clinic in 3 months