Pain & Symptom Management
Pain is a major concern among many patients with serious illness, as well as their family care partners. Pain often interferes with patients’ ability to perform valued activities and can lead to increased psychological distress for patients and family. Because pain is often unpredictable and complex, it can be challenging for patients and caregivers to manage, leading to a perceived lack of control. While pain medication can be helpful, it has some drawbacks including negative side effects such as drowsiness, nausea, and constipation.
Pain coping skills training is a non-pharmacological approach to pain management that teaches patients cognitive and behavioral skills (e.g., relaxation, imagery, activity pacing) that can help reduce pain psychological distress, and increase engagement in meaningful activities. Pain coping skills training has been shown to improve pain-related outcomes for patients with diseases such as arthritis, cancer, and back pain. While the focus of the intervention is typically on the patient, pain coping skills can also be targeted to patient-caregiver dyads. In caregiver-assisted interventions, caregivers learn skills alongside the patient and help the patient practice and apply skills in challenging situations. Caregivers are also encouraged to use the skills to manage their own psychological distress.
Caregiver-Assisted Pain Coping Skills Training for Advanced Cancer
Pain is particularly prevalent and distressing among patients with advanced cancer, and their family caregivers are often integrally involved in pain management. We tested a brief 3-session intervention delivered via videoconference for patients with advanced cancer and pain and their caregivers. In this study, 202 patient-caregiver dyads were randomized to receive either the caregiver-assisted pain coping skills intervention or educational resources about pain management. Results suggested that the caregiver-assisted pain coping skills intervention was particularly helpful for caregivers, as they reported significant increases in caregiving satisfaction and decreased anxiety. The pain education information was also helpful as caregivers in both conditions reported improvements in self-efficacy, and patients reported improvements in self-efficacy, pain severity and interference, and psychological distress.
Funded by the National Institute of Nursing Research
Caregiver-assisted Pain Coping Skills Training for Dementia
Pain is a common, undertreated, and often disabling condition in persons with dementia (PWD) that impacts both the person and their caregivers. The overwhelming majority of research on pain evaluation and management in PWD focuses on those with advanced disease living in long term care facilities. Given the prevalence of pain in community-dwelling patients with less advanced disease, and the impact of pain on patients and caregivers, it is important to develop pain management programs for these vulnerable individuals. To develop a relevant pain coping skills program for this population, we first conducted interviews with ten patient-caregiver dyads to gather feedback about intervention content and delivery. We then implemented the 5-session intervention with 11 patient-caregiver dyads. Caregivers reported high satisfaction ratings. They also reported using the pain coping skills on a regular basis. Given these positive preliminary findings, we are currently seeking funding to conduct a larger study.
Funded by the National Palliative Care Research Center