Pain Management Education for Patients: 8 Key Elements

Pain management education gives patients a greater understanding of their treatment plan, and the opportunity to ask questions and express concerns. Done well, it empowers patients to make the most of their health care.

That matters because of the high rates of chronic pain among U.S. adults, and because for some conditions over 40% of patients face increased health challenges by misunderstanding, forgetting, or ignoring the advice of healthcare providers.

What should patients expect from a pain management specialist?

Many patients won't know what to expect when connecting with a pain management specialist for the first time. Whether they're recovering from a one-time surgery or taking first steps to address chronic pain, feeling prepared for the appointment can set them at ease.

The rapport established in this initial appointment can impact the likelihood of a patient taking prescribed medications and returning for regular visits. Setting expectations prior to their appointment gives patients the opportunity to mentally prepare and ask questions. This can be done through an information document sent via email in the weeks leading up to the appointment.

An ideal pain management appointment should include:

• Medical history, including family and social history, all past surgical history, allergies, current health status, and medications a patient is currently taking or have recently stopped taking.
• Comprehensive pain assessment to determine severity, nature of acute and chronic pain, and pain experience. There are many types of pain assessments, each with their own advantages and disadvantages.
• Questionnaires such as the Opioid Risk Tool (ORT) and the Pain Medication Questionnaire (PMQ) can help assess medication usage and risk related to pain management.
• Physical exam. While many patients will have had a physical exam before, a quick refresh can be useful, especially following the rise of telehealth from the COVID-19 pandemic. Dr. Paul Hyman suggests the physical exam is an important doctor-patient ritual, providing human connection, reassurance through data, and the opportunity to demonstrate medical knowledge.
• A cognitive function test. Because both pain and pain medication can have impacts on cognition, a baseline cognitive assessment is essential for monitoring treatment efficacy. For example, for fibromyalgia patients, measuring reduced "fibro fog" can indicate one aspect of successful treatment.
• Treatment plan that includes information about the disease or ailment, health goals, treatment options, potential side effects, and expected length of treatment. It's a good practice to provide both physical and emailed copies.
• Scheduled follow-ups to regularly measure the results of pain management strategies. Forgetfulness accounts for between 8%–44% of missed appointments, so scheduling simple reminders prior to follow-up appointments can be beneficial to any practice.
• Pain education and support. A combination of valuable resource documents and face-to-face discussion is key for pain management education for patients.

Why is pain management education important?

Dedicating time to educating patients helps healthcare professionals:

Build trust

With the power dynamics at play in provider-patient relationships, trust-building is essential for positive health outcomes. A case study shows that even in cases where providers cannot alleviate the pain of chronic pain patients, many of them can still view primary care provider (PCP) relationships positively.

According to this study, this satisfaction is tied to:

• Feeling listened to by their primary care provider
• Receiving attentive and prompt responses
• Having their pain be believed
• Being offered suggestions other than medication
• Honest assessments of pain care expectations
• Having steps taken towards diagnosis

Using tools like health questionnaires can give healthcare professionals an initial overview of symptoms. From there, they can ask more detailed questions, and give patients the opportunity to share their unique concerns and experiences.

This strategy allows providers to receive better information, deliver well-informed diagnoses, and address comorbidities. Along with this, individual pain management education for patients demonstrates providers' listening skills and investment in patient wellness.

Improve patient compliance

Nearly 40% of chronic pain patients do not take prescription medications as prescribed. Fear of addiction, side effects, and additional treatment costs can be barriers to pain management. Open and honest education about pain medicine can help to manage these fears and combat poor compliance.

Patient education can also be a factor in making lifestyle changes. Tools like cognitive assessments give patients vital information about the state of their overall health. While chronic pain is associated with 21% increased odds of cognitive impairment for every two years it persists, many adults do not notice until their cognition is measured.

Miami Pain & Diagnostic clinic increased compliance for cognitive assessments by including the tests in their intake process. With awareness about how their pain was affecting long-term brain health, they took more steps towards improving their health.

Many healthcare professionals experience frustration about patients being unwilling to change their habits, and can end up dismissing the value of education and lifestyle counseling. But while education might not make people completely overhaul their lifestyle, it can guide them towards smaller changes.

Promote safety and better health outcomes

According to a systematic review by the National Center for Drug Abuse Statistics, 9.7 million Americans aged 12 and older misuse painkillers.

While doctors have made great strides to reduce overprescribing, many chronic pain patients are struggling to access essential pain medicine. This challenge has created a unique challenge for doctor-patient relationships as healthcare professionals work to find the balance without losing trust with patients.

Patient education is the first step in making sure patients know how to safely use different pain medicines from the start. Tools like the Opioid Risk Tool (ORT) can identify a patient's risk of opioid use disorder early and make a treatment plan.

What gets in the way of patient education?

There are several factors in pain education that might prevent patients from sticking to their treatment plan.

These obstacles include:

• Inadequate assessment of pain. For example, many autistic patients do not show as many facial indicators of pain as their neurotypical counterparts. Misunderstanding the degree or nature of a patients' pain can lead to insufficient treatment and education.
• Unaddressed comorbidities. Comorbidities are other conditions a patient has alongside their pain. Chronic pain occurs in up to 70% of people with anxiety and depressive disorders. Pain management education for patients with anxiety may need to include components that help manage stress as well as pain relief.
• Inconsistent recommendations. Gaps in communication across the healthcare team can lead to inconsistent information, and negatively impact patients' trust in their doctors.
• Competing sources of education. The emotional toll of long wait times for pain clinics can lead patients to seek out their own knowledge and resources. Unfortunately, health misinformation is prevalent on social media, and can lead patients away from education that is backed by evidence.
• Lack of time dedicated to patient education. Short consultation times are one of the highest barriers to patient satisfaction with the UK's National Health Service. When there isn't time for patients to ask questions and connect with their clinicians, suggested interventions can be less valuable.

Overall, the more that healthcare providers can get to know their patients as individuals, the better their pain management education will be.

8 key elements of pain management education

Pain management education for patients includes 8 key elements:

Different pain types

Pain education includes helping patients understand the difference between acute and chronic pain. Educating patients on different pain types can help them name their experiences, and shape their treatment plan.

In the United States, just under 21% of people experience chronic pain, and 6.9% experience high impact chronic pain.

Postoperative pain is a type of acute pain that requires a treatment plan and pain management education for patients. If this pain is not properly treated, it can lead to complications, extended recovery time, and the risk of becoming chronic pain. Including this information in patient education enforces the importance of following a treatment plan.

Conditions and symptoms

Educating patients also includes helping them understand the connections between their particular symptoms, conditions, and experiences of pain. This can be helpful in setting expectations around recovery. It's also important to record and track symptoms over time, and include patients in the process of recording any changes they observe.

Chronic pain has many different origins, but two common types are neuropathic pain and chronic inflammatory pain. Some examples to be aware of include:

Both types of chronic pain have a long-term impact on the brain. Highlighting the cognitive impact of persistent pain can give patients answers about the origin of symptoms like brain fog.

Goals of pain relief

Goal setting gives patients realistic expectations for recovery and turns general advice into specific steps they can take. 48% of chronic pain patients name reducing pain intensity as their top priority, but chronic pain also has a significant impact on patients' cognitive, emotional, and social wellness. As a result, each patient's pain relief goals might look a bit different.

Establishing pain management goals:

• Gives treatment plans a clear direction
• Establishes that recovery is a personal journey and can look different for every patient
• Sets expectations about recovery times and possibility
• Builds greater understanding in the patient-provider relationship

Some goals might include being able to work part-time hours, walk around the neighborhood, or sleep for more than five hours per night. Keeping goals realistic and attainable helps build self-efficacy.

Mental health

Approximately 20% of chronic pain patients experience suicidal ideation, with 5%–14% attempting suicide. Educating patients on the mental health toll of chronic pain, as well as providing resources for managing these symptoms and accessing appropriate care, is a key part of treatment.

Stress measurement assessments help providers measure the extent to which stress is impacting patients' lives. With 27% of Americans reporting that most days they feel too stressed to function, these assessments can provide key insights when included in intake forms.

Treating mental health conditions alongside chronic pain often has a positive impact. In fact, for neuropathic pain patients, antidepressants have demonstrated a 50% reduction of pain. Assessments such as the Patient Health Questionnaire-9 (PHQ-9) can help measure depressive symptoms that coexist with pain, and in the Creyos platform, will automatically notify a provider if the patient indicates concerns about self-harm.

Cognitive health

54% of chronic pain patients report at least one challenge with cognitive function, including:

• Deficits in executive function
• Brain fog
• Poor memory
• Struggles with concentration

Conversations about cognitive health can feel stigmatizing for some patients, and they may be reluctant to receive questions about their cognition.

Physicians can reduce stigma by using quick, objective measurements of current brain health and treating cognition metrics like any other biomarker. The Creyos platform measures cognitive health using short, engaging tasks.

Providing patient education about the long-term impact of pain on cognition can reduce this stigma, and ideally get patients on board with regular cognitive health care assessments.

Pain medications

There are many kinds of pain management medications available for pain patients. Patient education about the benefits and risks of opioid and nonopioid options can help guide the pain management plan.

Before you prescribe opioids or other new medications, having patients take the Pain Medication Questionnaire (PMQ) and the Opioid Risk Tool (ORT) can help measure their risk of substance use disorder. Opioids have been thought to have a better effect with pain management, but studies suggest this may not be the case.

However, many patients who are successfully managing their pain with opioids have significant fear of having them taken away. Mindfully managing any discussions about tapering is essential to maintaining patient-provider trust.

Safety guidelines for pain medication

Medication safety education covers following dosing instructions, knowing which side effects need medical attention, and storing medication safely. Once medications have been determined, patients benefit from educational resources and a way to contact providers in case of confusion.

Review medication best practices including:

• Following provider instructions for taking medication
• Starting at the lowest effective dose for the shortest amount of time
• Not stopping any prescription medication suddenly
• Not combining over-the-counter (OTC) and prescription pain medicines without talking to their provider
• Storing medication in a safe place

Anxiety about side effects can impact patient compliance. Setting expectations, as well as noting which side effects should make them seek medical help, can help mitigate uncertainty.

For opioids, making note of overdose symptoms can help save lives. Having naloxone in the house can be an extra safety measure for patients at risk of overdose.

Non-pharmacological pain treatment

Less than 50% of patients with neuropathic pain will achieve adequate pain relief with a single agent, but non-pharmacological interventions may be an alternative to additional medications.

Medication is far from the only tool for managing pain, and patients can find relief with pain management techniques such as:

• Movement exercises like yoga, walking, and tai chi
• Mindfulness meditation
• Massage from a licensed professional
• At-home acupressure tools
• Acupuncture (particularly for migraines and fibromyalgia)
• Applying heat and ice
• Cognitive behavioral therapy

Acupuncture has shown modest effects for some types of pain.

Social isolation is common for chronic pain patients, and can exacerbate symptoms. Community support groups are another resource for combating the dangers of loneliness.

How patient education strengthens the provider relationship

Pain management education is an opportunity to strengthen the connection between patients and healthcare providers and improve patient health outcomes.

As we discussed, there are multiple components to pain management education including physical, mental, cognitive, and behavioral symptoms. With the help of cognitive tasks and trusted self-report questionnaires, you can simplify the assessment process and dive into individual patient needs.