Page 34 Guide to Pain Management in Low-Resource Settings

22 Harald C. Traue et al.

Table 1
Psychological interventions and therapy targets
Need for Psychological
Intervention Th erapeutic Targets Treatment Context Expertise*
Patient training Educate, i.e., expand patient’s sub- General medicine +
jective pain theory (integration of
psychosocial aspects)
Handling of medications Reduce medication, use correct General medicine ++
medication, and prevent misuse
Relaxation training Learn how to use relaxation to Psychologist + physiotherapist +
cope with pain and stress
Resource optimization Analyze and strengthen own General medicine +
resources for coping with pain
Activity regulation Optimize activity levels (balance Physician + psychologist/psychiatrist ++
between rest and activity): reduce
fear-motivated avoidance and
increase activity level
Pain and coping Optimize pain-coping capabilities Psychologist/psychiatrist ++
Involvement of caregivers Involve patient’s caregivers in General medicine +
reaching therapy targets
Improvement of self-observation Find a personal connection Psychologist/psychiatrist +++
between the pain and internal or
external events, which can help
establish ways to control the pain.
Analyze conditions that increase
pain and stress
Stress management Learn systematic problem-solving Psychologist/psychiatrist +++
tools and how to cope with stress
Learning how to enjoy activities Strengthen activities the patient General medicine/physiotherapist +
enjoys and likes to do
Communication Change inadequate pain commu- General medicine or psychologist +
nication and interaction
Developing perspectives for the Develop realistic perspectives for General medicine +
future the future (professional, private)
and initiate action plans
Special Th erapies
Cognitive restructuring Modify catastrophizing and Psychologist/psychiatrist +++
depressive cognitions
Biofeedback Learn how to activate specifi c Psychologist ++++
motor and neuronal (vegetative
and central nervous) functions
and learn better self-regulation
Functional restoration Restore private and professional Interdisciplinary: orthopedic physician + ++++
functionality; reduce subjec- physiologist
tive impairment perception and
movement-related anxiety
* Low (+) to high (++++).