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13 Articles in Volume 12, Issue #11
“Doc” Holliday: A Story of Tuberculosis, Pain, and Self-medication in the Wild West
"Doc's" Woman: Doc Holliday's Wife
Activation of Latent Lyme Disease Following Epidural Steroid Injection: Case Challenge
An Overview of Complex Regional Pain Syndrome and its Management
Extracorporeal Shock Wave Therapy: Applications in Tendon-related Injuries
Mission Impossible—Developing a Program to Help Chronic Pain Patients
New Ideas for Helping Difficult Pain Patients
Postoperative Pain Relief After Knee and Hip Replacement: A Review
Using Dynamic MRI to Diagnose Neck Pain: The Importance of Positional Cervical Cord Compression (PC3)
December 2012 Pain Research Updates
Best Practices For High-dose Opioid Prescribing
Does Sulindac Affect Renal Function Less Than Other NSAIDs?
The Bewildering Terminology of Genetic Testing

Mission Impossible—Developing a Program to Help Chronic Pain Patients

When pain cannot be resolved by medical interventions, coaching can be instrumental in bringing mental and physical restoration. The motivating support of a coach moves clients to become enthused managers of their pain.

I fell asleep at the wheel and careened off the road at a dangerous spot, and flipped over so many times my Jeep was unrecognizable when it came to a stop.

Days later when I emerged from the coma, I came to understand what was meant by “incomplete C4 spinal cord injury”—muscle spasticity with weakness on my left side and impaired sensation on my right. At that point, the burning nerve pain seemed manageable after what I’d lived through. Thinking these were the primary issues I had to deal with, I jumped enthusiastically into the recovery process and celebrated progress as I learned how to walk, dress, feed myself, and write all over again.

Two years later, just when I was regaining a “normal” life, the pain increased significantly. A magnetic resonance imaging examination revealed a spinal cord syringomyelia (syrinx) at the site of my injury. Pressure from the fluid-filled cyst was causing searing pain throughout my entire body—the pain was constant and unyielding to medications. The verdict: inoperable, untreatable.

I felt my life was over. The 3 weeks I eventually spent in a pain clinic, however, gave me a shred of hope that I might be able to control the pain. I had learned some lifestyle adjustments that reduced pain flares and helped me focus on things other than my pain. Back home, though, I was slipping back into the role of helpless victim. My family hovered and protected me; everyone was consumed by my pain.

Realizing no one could help me but myself, I went on a search for more ways to cope, and read about the powerful role of the brain in perceiving pain.1 I began to understand how something as simple as my own thinking could make a difference in my pain experience.2

Prior to my accident, I had been trained as a life coach, and from that experience I recognized coaching as a discipline well suited to moving someone from being “stuck” to becoming the “driver.” But life coaching and wellness coaching are geared primarily toward highly motivated, successful people who want to lose a few pounds or take on new goals. The question remained, “Would coaching methods work for people with chronic pain?”

I started and refined an effective pain management routine for myself, then coached an acquaintance who had been to a pain clinic but had fallen back into old habits of focusing on the pain and neglecting mental and physical techniques for pain control. Borrowing my new-found courage, she also put together a well-organized pain management program and got her pain under control. Her progress was transformative.

What if my approach could be used to help others who suffered with chronic pain?

Developing a Program
I discovered “the secret” to managing pain was only a secret because an effective model had yet to be developed and disseminated. Knowing from personal experience that coaching gets people actively engaged and moving forward, I dreamed of coaching chronic pain patients to manage their pain.

Table 1. Take Courage Coaching Clietn POQ Scores - Paired Samples Test

Figure 1. Graphic display for intake to 12 months.

My mission to help pain patients grew into developing a new coaching field that could help the more than 100 million people in the United States who suffer with chronic pain.3 From this, Take Courage Coaching (TCC) was born.

Right away I learned that people who seek to eliminate chronic pain have seen many doctors, tried numerous therapies, often spent time with mental health professionals, and sometimes go to a pain clinic. What they lack is ongoing support and motivation to make changes that will improve their experience with pain over the long haul. A high percentage of chronic pain patients give up and give in to a life filled with pain, low productivity, and isolation.3

Physicians know that a patient’s active engagement in lifestyle changes makes the difference between short-term fixes and long-term solutions. Unfortunately, moving chronic pain patients from a passive “fix-me” mode to an active self-management mode requires focused attention, more time than physicians and ancillary services can provide, and would be cost-prohibitive.

As I pieced together the essential elements of managing my own pain, it became clear that TCC needed to develop a coaching system that would help clients learn the skills of pain management and provide the support that leads them to embrace managing their pain independently. Through the use of proven science-based practices, clients are doing just that.

The Take Courage Coaching Model
The TCC approach takes the latest in brain science and translates it into knowledge a person in pain can understand and implement. Within an educational model, the client learns how lifestyle elements affect pain. Positive psychology, cognitive behavioral therapy, and motivational interviewing draw the client into personalized solutions.

Whereas physicians and therapists continue to manage emergencies, therapies, medications, and the mental roller coaster of chronic pain patients, TCC supports and guides clients through a process of discovery, lifestyle adjustments, and goal-setting strategies that educate, empower, and gives them accountability as they design their own pain management routine. I call this pain management coaching.

Coaches guide a client from a pain-driven existence to a state in which they can self-manage what they can control—lifestyle habits and patterns of thinking that increase pain. Many healthcare providers tell me pain management coaching is the missing link in chronic pain treatment and the most effective long-term “fix” for patients who have bounced between physician offices, emergency rooms, and pharmacies.

A coach trained to work with chronic pain clients understands how to motivate the client from being a helpless victim to being a chronic pain manager. Because the TCC model of coaching was structured by a coach who successfully manages chronic pain, clients are introduced to evidence-based strategies that work to reduce and manage chronic pain.

Table 2. TCC Client Cases

How it Works
TCC is done via two weekly telephone sessions—one individual session and one small-group session. Ideally, a client spends 1 year with TCC. A toolbox-full of knowledge and practiced skills—from how the brain reacts to pain to how it responds to thoughts; from breathing techniques to the role of hydration and exercise—gives clients the ability to return to their lives.

At first glance, coaching by telephone might seem too hands-off, but chronic pain patients are a population often limited by immobility. Telephone coaching makes the reach of TCC’s system limitless—coaching a client is not restricted by availability of specialized coaching nor by access to a coach.

TCC coaches excel in helping clients tap into values and personal skills—motivating factors that enable them to push through obstacles and achieve their goals. Support, accountability, and goal-oriented problem solving encourage engagement as clients partner in their own self-care. The result? Improved outcomes.

TCC data is collected using the Patient Outcome Questionnaire—with measurements taken before the coaching intervention begins, at 6 months, and at 12 months when coaching is completed. The first 14 clients’ diagnoses included chronic spinal pain, hip dysplasia, degenerative disc disease, fibromyalgia, degenerative stenosis, occipital neuralgia, neuropathy, herniated discs, peripheral neuropathy, and arthritis. Clients not only verbally express a positive change in lifestyle, but the data also clearly demonstrates a statistically significant decrease in pain levels (Table 1, Figure 1).

Initial and quarterly assessments measure client progress, and coaches incorporate medical recommendations into the patient’s goal setting. In this way, the primary physician can use TCC as an adjunct to therapeutic treatment. Having referred patients to TCC, and currently involved in a pilot study of its methods, Roy O. Elam, MD, Medical Director of the Vanderbilt Center for Integrative Health, Nashville, Tennessee, says, “The outcome data that TCC is tracking thus far substantiates the efficacy of the program.”

Mission in Progress
Over the past year, TCC’s pain coaching curriculum has trained 10 coaches to work with TCC clients. Table 2 provides a review of two client cases—before coaching and after—showing the benefits of the program.

While medical interventions are essential in pain management, coaching a client to be an effective self-manager promises to reduce the burden on health care organizations and insurers by transitioning clients to less dependence on expensive treatments, pharmaceuticals, and frequent office/emergency department visits.

Clients who develop personal confidence in their ability to manage pain are well on the way to healthy and productive lives. TCC provides education and tools that can be employed as at-home resources; clients learn to tap into their own capabilities and strengths. Their successful resolution of pain returns them to family, work, and rewarding activities.

Last updated on: March 14, 2016
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