Clinical Considerations for Behavioral Pain Management in Co-Occurring Acute and Chronic Pain Presentations

Abstract

Objective:

Behavioral pain management treatments are typically provided after a multidisciplinary assessment determining whether the nature of pain is expected to be short-term (i.e., acute) or whether the pain is persistent (i.e., chronic). However, many of the standard ways clinicians approach pain management are challenged by the presentation of co-occurring acute and chronic pain experiences, such as can be the case in sickle cell disease (SCD), headache management (migraines and daily persisting headaches), chronic musculoskeletal pain with reinjury, and juvenile idiopathic arthritis, among others. Such overlapping pain presentations can involve conflicting treatment approaches for pain management. Currently, there is burgeoning, yet still limited, understanding of the complexity of co-occurring acute and chronic pain presentations.

Methods:

Given the unique pain presentation common in SCD, among other conditions, we review how behavioral pain management strategies can utilize complementary approaches to address the experience of co-occurring acute and chronic pain.

Results:

This commentary provides a brief historical review of the evolution of our understanding of pain perception and psychological treatments for pain. We propose an innovative clinical framework for behavioral pain management of co-occurring acute and chronic pain.

Conclusions:

We hope to enhance the current dialogue around pain perception and pain burden to address the unique needs of co-occurring acute and chronic pain presentations. Ongoing areas for research and clinical considerations are also discussed.

Implications for Impact Statement

There is increasing awareness of the heterogeneity of pain conditions involving both acute and chronic pain. This commentary proposes a new care model for behavioral pain management for individuals experiencing co-occurring acute and chronic pain. Behavioral pain management strategies should consider complementary and flexible approaches that address the cumulative experience of both acute and chronic pain.

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References

American Society of Anesthesiologists Task Force on Chronic Pain Management and American Society of Regional Anesthesia and Pain Medicine . (2010). Practice guidelines for chronic pain management: An updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology, 112(4), 810–833. 10.1097/ALN.0b013e3181c43103

Birnie

K. A.

Noel

Chambers

C. T.

Uman

L. S.

, & Parker

J. A.

(2018). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, 10(10), CD005179. 10.1002/14651858.CD005179.pub4

Brandow

A. M.

Carroll

C. P.

Creary

Edwards-Elliott

Glassberg

Hurley

R. W.

Kutlar

Seisa

Stinson

Strouse

J. J.

Yusuf

Zempsky

, & Lang

(2020). American Society of Hematology 2020 guidelines for sickle cell disease: Management of acute and chronic pain. Blood Advances, 4(12), 2656–2701. 10.1182/bloodadvances.2020001851

Branstetter-Rost

Cushing

, & Douleh

(2009). Personal values and pain tolerance: Does a values intervention add to acceptance? The Journal of Pain, 10(8), 887–892. 10.1016/j.jpain.2009.01.001

Bueno-Gómez

(2017). Conceptualizing suffering and pain. Philosophy, Ethics, and Humanities in Medicine, 12(1), 7. 10.1186/s13010-017-0049-5

Busch

Magerl

Kern

Haas

Hajak

, & Eichhammer

(2012). The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing—An experimental study. Pain Medicine, 13(2), 215–228. 10.1111/j.1526-4637.2011.01243.x

Claar

R. L.

Guite

J. W.

Kaczynski

K. J.

, & Logan

D. E.

(2010). Factor structure of the Adult Responses to Children’s Symptoms: Validation in children and adolescents with diverse chronic pain conditions. The Clinical Journal of Pain, 26(5), 410–417. 10.1097/AJP.0b013e3181cf5706

Coakley

, & Wihak

(2017). Evidence-based psychological interventions for the management of pediatric chronic pain: New directions in research and clinical practice. Children, 4(2), 9. 10.3390/children4020009

Cohen

L. L.

(2008). Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics, 122(Suppl. 3), S134–S139. 10.1542/peds.2008-1055f

10.

Connolly

M. E.

Bills

S. E.

, & Hardy

S. J.

(2019). Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease. Pediatric Blood & Cancer, 66(9), e27823. 10.1002/pbc.27823

11.

Dampier

Palermo

T. M.

Darbari

D. S.

Hassell

Smith

, & Zempsky

(2017). AAPT diagnostic criteria for chronic sickle cell disease pain. The Journal of Pain, 18(5), 490–498. 10.1016/j.jpain.2016.12.016

12.

Darbari

D. S.

Ballas

S. K.

, & Clauw

D. J.

(2014). Thinking beyond sickling to better understand pain in sickle cell disease. European Journal of Haematology, 93(2), 89–95. 10.1111/ejh.12340

13.

Di Lernia

Lacerenza

Ainley

, & Riva

(2020). Altered interoceptive perception and the effects of interoceptive analgesia in musculoskeletal, primary, and neuropathic chronic pain conditions. Journal of Personalized Medicine, 10(4), 201. 10.3390/jpm10040201

14.

Di Lernia

Serino

, & Riva

(2016). Pain in the body. Altered interoception in chronic pain conditions: A systematic review. Neuroscience and Biobehavioral Reviews, 71, 328–341. 10.1016/j.neubiorev.2016.09.015

15.

Elliott

K. R.

, & Jones

(2019). The association between frequency of opioid misuse and opioid use disorder among youth and adults in the United States. Drug and Alcohol Dependence, 197, 73–77. 10.1016/j.drugalcdep.2019.01.008

16.

Fisher

Law

Dudeney

Palermo

T. M.

Stewart

, & Eccleston

(2018). Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews, 9, CD003968. 10.1002/14651858.CD003968.pub5

17.

Gaither

J. R.

Shabanova

, & Leventhal

J. M.

(2018). U.S. national trends in pediatric deaths from prescription and illicit opioids, 1999–2016. JAMA Network Open, 1(8), e186558. 10.1001/jamanetworkopen.2018.6558

18.

Georgiou

Matthias

Kobel

Kettner

Dreyhaupt

Steinacker

J. M.

, & Pollatos

(2015). Interaction of physical activity and interoception in children. Frontiers in Psychology, 6, 502. 10.3389/fpsyg.2015.00502

19.

Ginzburg

Tsur

Karmin

Speizman

Tourgeman

, & Defrin

(2015). Body awareness and pain habituation: The role of orientation towards somatic signals. Journal of Behavioral Medicine, 38(6), 876–885. 10.1007/s10865-015-9676-8

20.

Grichnik

K. P.

, & Ferrante

F. M.

(1991). The difference between acute and chronic pain. The Mount Sinai Journal of Medicine, 58(3), 217–220.

21.

Herbert

M. S.

Goodin

B. R.

Pero

S. T.

Schmidt

J. K.

Sotolongo

Bulls

H. W.

Glover

T. L.

King

C. D.

Sibille

K. T.

Cruz-Almeida

Staud

Fessler

B. J.

Bradley

L. A.

, & Fillingim

R. B.

(2014). Pain hypervigilance is associated with greater clinical pain severity and enhanced experimental pain sensitivity among adults with symptomatic knee osteoarthritis. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 48(1), 50–60. 10.1007/s12160-013-9563-x

22.

Hudgins

J. D.

Porter

J. J.

Monuteaux

M. C.

, & Bourgeois

F. T.

(2019). Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLoS Medicine, 16(11), e1002922. 10.1371/journal.pmed.1002922

23.

Jacob

Mack

A. K.

Savedra

Van Cleve

, & Wilkie

D. J.

(2014). Adolescent pediatric pain tool for multidimensional measurement of pain in children and adolescents. Pain Management Nursing, 15(3), 694–706. 10.1016/j.pmn.2013.03.002

24.

Lee

R. R.

Rashid

Ghio

Thomson

, & Cordingley

(2017). Chronic pain assessments in children and adolescents: A systematic literature review of the selection, administration, interpretation, and reporting of unidimensional pain intensity scales. Pain Research & Management, 2017, 7603758. 10.1155/2017/7603758

25.

Logan

D. E.

Simons

L. E.

, & Carpino

E. A.

(2012). Too sick for school? Parent influences on school functioning among children with chronic pain. Pain, 153(2), 437–443. 10.1016/j.pain.2011.11.004

26.

Louw

Diener

Butler

D. S.

, & Puentedura

E. J.

(2011). The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of Physical Medicine and Rehabilitation, 92(12), 2041–2056. 10.1016/j.apmr.2011.07.198

27.

Lynch-Jordan

Kaishikar-Zuck

Soumitri

Cunningham

Wolf

Stahlman

Rogers

Burke

Barnett

Peugh

Rose

Szabova

, & Goldschneider

(2014). Functional improvement is observed before pain reduction in children treated for chronic pain. The Journal of Pain, 15(4), S120–S226.

28.

Mac Neil

B. A.

, & Hudson

C. C.

(2018). Patient experience and satisfaction with acceptance and commitment therapy delivered in a complimentary open group format for adults with eating disorders. Journal of Patient Experience, 5(3), 189–194. 10.1177/2374373517748640

29.

Mathur

V. A.

Kiley

K. B.

Carroll

C. P.

Edwards

R. R.

Lanzkron

Haythornthwaite

J. A.

, & Campbell

C. M.

(2016). Disease-related, nondisease-related, and situational catastrophizing in sickle cell disease and its relationship with pain. The Journal of Pain, 17(11), 1227–1236. 10.1016/j.jpain.2016.08.003

30.

Matthie

Ross

Sinha

Khemani

Bakshi

, & Krishnamurti

(2019). A qualitative study of chronic pain and self-management in adults with sickle cell disease. Journal of the National Medical Association, 111(2), 158–168. 10.1016/j.jnma.2018.08.001

31.

McClish

D. K.

Smith

W. R.

Levenson

J. L.

Aisiku

I. P.

Roberts

J. D.

Roseff

S. D.

, & Bovbjerg

V. E.

(2017). Comorbidity, pain, utilization, and psychosocial outcomes in older versus younger sickle cell adults: The PiSCES Project. BioMed Research International, 2017, 4070547. 10.1155/2017/4070547

32.

Melzack

(1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1(3), 277–299. 10.1016/0304-3959(75)90044-5

33.

Melzack

(1999). From the gate to the neuromatrix. Pain, 82(Suppl. 6), S121–S126. 10.1016/S0304-3959(99)00145-1

34.

Melzack

, & Wall

P. D.

(1965). Pain mechanisms: A new theory. Science, 150(3699), 971–979. 10.1126/science.150.3699.971

35.

Mercadante

Arcuri

, & Santoni

(2019). Opioid-induced tolerance and hyperalgesia. CNS Drugs, 33(10), 943–955. 10.1007/s40263-019-00660-0

36.

Osland

S. T.

Steeves

T. D.

, & Pringsheim

(2018). Pharmacological treatment for attention deficit hyperactivity disorder (ADHD) in children with comorbid tic disorders. Cochrane Database of Systematic Reviews, 6(6), CD007990. 10.1002/14651858.CD007990.pub3

37.

Palermo

T. M.

(2009). Assessment of chronic pain in children: Current status and emerging topics. Pain Research & Management, 14(1), 21–26. 10.1155/2009/236426

38.

Pielech

Lunde

C. E.

Becker

S. J.

Vowles

K. E.

, & Sieberg

C. B.

(2020). Comorbid chronic pain and opioid misuse in youth: Knowns, unknowns, and implications for behavioral treatment. American Psychologist, 75(6), 811–824. 10.1037/amp0000655

39.

Pielech

Vowles

K. E.

, & Wicksell

(2017). Acceptance and commitment therapy for pediatric chronic pain: Theory and application. Children, 4(2), 10. 10.3390/children4020010

40.

Pringsheim

, & Steeves

(2011). Pharmacological treatment for Attention Deficit Hyperactivity Disorder (ADHD) in children with comorbid tic disorders. Cochrane Database of Systematic Reviews, 4(4), CD007990. 10.1002/14651858.CD007990.pub2

41.

Ritz

Meuret

A. E.

Trueba

A. F.

Fritzsche

, & von Leupoldt

(2013). Psychosocial factors and behavioral medicine interventions in asthma. Journal of Consulting and Clinical Psychology, 81(2), 231–250. 10.1037/a0030187

42.

Roditi

, & Robinson

M. E.

(2011). The role of psychological interventions in the management of patients with chronic pain. Psychology Research and Behavior Management, 4, 41–49. 10.2147/PRBM.S15375

43.

Ruscheweyh

Kreusch

Albers

Sommer

, & Marziniak

(2011). The effect of distraction strategies on pain perception and the nociceptive flexor reflex (RIII reflex). Pain, 152(11), 2662–2671. 10.1016/j.pain.2011.08.016

44.

Sil

Cohen

L. L.

, & Dampier

(2016). Psychosocial and functional outcomes in youth with chronic sickle cell pain. The Clinical Journal of Pain, 32(6), 527–533. 10.1097/AJP.0000000000000289

45.

Sil

Cohen

L. L.

Bakshi

Watt

Hathaway

Abudulai

, & Dampier

(2020). Changes in pain and psychosocial functioning and transition to chronic pain in pediatric sickle cell disease: A cohort follow-up study. The Clinical Journal of Pain, 36(6), 463–471. 10.1097/AJP.0000000000000827

46.

Sil

Goldstein-Leever

Travers

Gilleland-Marchak

Alexander

Thompson

Griffin

McCracken

, & New

(2019). Enhancing pain assessment in pediatric sickle cell disease by applying quality improvement science. Clinical Practice in Pediatric Psychology, 7(4), 335–346. 10.1037/cpp0000277

47.

Smith

W. R.

McClish

D. K.

Levenson

Aisiku

Dahman

Bovbjerg

V. E.

Roseff

, & Roberts

(2018). Predictive ability of intermittent daily sickle cell pain assessment: The PiSCES Project. Pain Medicine, 19(10), 1972–1981. 10.1093/pm/pnx214

48.

Smith

W. R.

Penberthy

L. T.

Bovbjerg

V. E.

McClish

D. K.

Roberts

J. D.

Dahman

Aisiku

I. P.

Levenson

J. L.

, & Roseff

S. D.

(2008). Daily assessment of pain in adults with sickle cell disease. Annals of Internal Medicine, 148(2), 94–101. 10.7326/0003-4819-148-2-200801150-00004

49.

Smith

B. M.

Villatte

J. L.

Ong

C. W.

Butcher

G. M.

Twohig

M. P.

Levin

M. E.

, & Hayes

S. C.

(2019). The influence of a personal values intervention on cold pressor-induced distress tolerance. Behavior Modification, 43(5), 688–710. 10.1177/0145445518782402

50.

Stinson

J. N.

Luca

N. J.

, & Jibb

L. A.

(2012). Assessment and management of pain in juvenile idiopathic arthritis. Pain Research & Management, 17(6), 391–396. 10.1155/2012/237258

51.

Sugawara

Terasawa

Katsunuma

, & Sekiguchi

(2020). Effects of interoceptive training on decision making, anxiety, and somatic symptoms. BioPsychoSocial Medicine, 14(1), 7. 10.1186/s13030-020-00179-7

52.

Treede

R.-D.

Rief

Barke

Aziz

Bennett

M. I.

Benoliel

Cohen

Evers

Finnerup

N. B.

First

M. B.

Giamberardino

M. A.

Kaasa

Korwisi

Kosek

Lavand'homme

Nicholas

Perrot

Scholz

Schug

, … Wang

S.-J.

(2019). Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19–27. 10.1097/j.pain.0000000000001384

53.

Treede

R.-D.

Rief

Barke

Aziz

Bennett

M. I.

Benoliel

Cohen

Evers

Finnerup

N. B.

First

M. B.

Giamberardino

M. A.

Kaasa

Kosek

Lavand'homme

Nicholas

Perrot

Scholz

Schug

Smith

B. H.

, ... Wang

S.-J.

(2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003–1007. 10.1097/j.pain.0000000000000160

54.

von Baeyer

C. L.

(2009). Children’s self-report of pain intensity: What we know, where we are headed. Pain Research & Management, 14(1), 39–45. 10.1155/2009/259759

55.

Wetherell

J. L.

Afari

Rutledge

Sorrell

J. T.

Stoddard

J. A.

Petkus

A. J.

Solomon

B. C.

Lehman

D. H.

Liu

Lang

A. J.

, & Atkinson

H. J.

(2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain, 152(9), 2098–2107. 10.1016/j.pain.2011.05.016

56.

Wicksell

R. K.

Kanstrup

Kemani

M. K.

Holmström

, & Olsson

G. L.

(2015). Acceptance and Commitment Therapy for children and adolescents with physical health concerns. Current Opinion in Psychology, 2, 1–5. 10.1016/j.copsyc.2014.12.029

57.

Yale

S. H.

Nagib

, & Guthrie

(2000). Approach to the vaso-occlusive crisis in adults with sickle cell disease. American Family Physician, 61(5), 1349–1356.

58.

Yancey

J. R.

Sheridan

, & Koren

K. G.

(2014). Chronic daily headache: Diagnosis and management. American Family Physician, 89(8), 642–648.

59.

Yazdani

, & Zeltzer

(2013). Treatment of chronic pain in children and adolescents. Pain Management, 3(4), 303–314. 10.2217/pmt.13.25

60.

, & Pryzbylkowski

(2015). Opioid induced hyperalgesia. Pain Medicine, 16(Suppl. 1), S32–S36. 10.1111/pme.12914