How a pain management program for patients and spouses can benefit their lives?

Our study analyzes the relationship between an educational intervention in families, and how this programme affects positively on the lives of people with chronic pain and their environment, decreasing the ratings in chronic back pain. We conducted the first trial of a family intervention for this physical condition. Research on relatives’ expressed emotion led to successful trials of family interventions for many psychiatric conditions. A randomized control trial (RCT) of a Pain Management Program (PMP) involving the patients, and their carers, was based on the successful family intervention used for schizophrenia (Kuipers, Leff, & Lam, 2002; Leff & Ballús-Creus, 2012). The PMP consisted of educational sessions and group sessions with the patients and carers and was compared with a waiting list control. There was an increase in the knowledge about pain of the patients and carers and a significant decrease in the patients’ ratings of their pain. Chronic pain can cause feelings like sadness, anger or anxiety, in both patients and carers, impairing their quality of life and consuming considerable hospital resources in the pain treatment.

We recruited an initial sample of 266 patients with their respective partners. The patients suffered from chronic back pain mainly due to degeneration consequent on aging and were being treated at the Pain Management Unit of the Hospital for non-oncologic pain, diagnosed as neuropathic or structural origin with a history of more than 6 months, they were between 18 and 70 years old. All patients in both the experimental and control groups, continued to receive their usual medical treatment. Patients and relatives were assessed at the start of the Program (baseline), after the end of the Program, or, in the case of Control Group, 6 months after the Program started and, finally at a 12-month follow-up. The PMP consisted of two parts: a workshop and group therapy. The workshop was educational, comprising four sessions, which covered the following subjects: (1) What is a back pain? (2) What medical treatments and alternatives exist? (3) What is the experience of the patient and the family? and (4) What can you do to coexist with pain?

The group therapy consisted of 12 sessions given over 6 months. It was informed by our previous finding that the best predictor of patients’ physical role impairment was carers’ critical comments, and the best predictor of their emotional role impairment was carers’ overinvolvement with the patients (Ballús-Creus, Rangel, Peñarroya, Pérez, & Leff, 2014). The group had to review and revise the concepts presented during the workshop, as well as to solve common everyday problems shared by the patients and to discuss issues. Problem solving and experiential techniques were used.

Of the 74 patients and their relatives who entered the study, 37 were randomized to the experimental group and 37 to the control group. Of these, 26 experimental patients and 27 control patients were fully assessed post-treatment. The main assessments were a 10-item pain knowledge scale and 2 pain assessment scales: The McGill Pain Questionnaire (MPQ) (Melzack, 1975) and the Visual Analogue Scale (VAS) (Huskisson, 1974). The number of appointments with a pain specialist during the trial was also recorded first from the baseline assessment to the post-treatment assessment, in which the experimental group participated in the program, and then from the post-treatment assessment to a second 6-month follow-up. All data were analyzed, and the processing proved that the two groups did not differ significantly on any variable.

This innovative program proved to be successful in increasing the knowledge about pain of the patients and their carers and in reducing the patients’ experience of pain. This was substantiated by the reduction of nearly 30% in the patients’ appointments with the pain specialist, representing a substantial saving of resources. These results open a window of opportunity for trials of the inclusion of family carers in programs for patients with other physical illnesses in which carers’ expressed emotion has been shown to adversely affect the outcome, such as diabetes and myocardial infarction. Including families and carers in programs for pain treatment improves the quality of life for the family living with the pain diagnosis. Even though they are not the patients, it is necessary that the treatment incorporates them, to ameliorate the effects of pain and the emotional consequences.