GOALS Intervention for Chronic Pain

A complex and incomplete picture of the underlying mechanisms and conditions resulting in chronic pain is emerging, and research may be addressing many aspects of chronic pain in different clinical conditions and patient groups.

Chronic pain is defined as pain that persists over 3 months. It can cause significant disability and economic hardship. Chronic pain affects between 3 and 4% of the United States population, is a significant contributor to healthcare utilization, and affects a significant portion of workplace productivity.\n

Chronic pain is commonly treated with nonpharmacological approaches. These include cognitive-behavioral therapy, relaxation training, biofeedback, exercise, and acupuncture. Nonsteroidal anti-inflammatories are commonly used to treat musculoskeletal pain. Medications are commonly used to treat pain associated with chronic inflammation. The use of prescription opioids is sometimes necessary for serious pain syndromes. There are many variations and combinations of these treatments.

When discussing the causes of pain in the setting of primary care, many people do not notice that they have a chronic pain problem, let alone that it is a chronic pain problem. Results from a recent paper describes signs of chronic pain in many different areas and settings that patients may not often notice or discuss. These signs should be part of the discussion with patients, their families, and their prescribers. The signs are as follows: pain, tenderness, diminished enjoyment of life, and loss of work, and sleep. In the next section of this article, we consider how to evaluate these signs based on the NICE guidelines.

Most adults (75%) reported getting chronic pain. It became more common with advancing age, and most reported having had it before. We should be aware of this and the impact it likely has on our society.

Although the vast majority of the chronically ill with chronic pain, and the very majority with chronic pain of all types, report relief of most symptoms within a mean of 4+ months of treatment with opioids, antidepressants, or NSAIDs, most experience little or no relief from these drugs, as well as opioids and antidepressants. A significant minority reports relief from opioids, antidepressants, and NSAIDs, but less frequently reports relief from either opioids, antidepressants, or NSAIDs, suggesting that no one type of chronic pain is consistently relievable with all treatments. Although chronic pain relief is often a desirable goal, such relief seems to be infrequently achieved when patients use the most popular treatments.

Interventions that promote goals may be an effective strategy to implement in chronic pain rehabilitation and may be worthy of further study with regards to the extent to which they facilitate other goals set for rehabilitation in chronic pain.

It is important to note that the present study does not allow us to draw any solid conclusions about the results because it was a single study with a sample size smaller than 60, and that participants were not randomly assigned to the goals-intervention and the usual care groups or to either of the two groups during follow-up. Our finding indicates that the participants who were allocated to the goals-intervention group experienced greater improvements in goals than participants who received the usual care.

The seriousness of chronic pain is not yet understood by all professionals. Despite the fact that studies suggest that a large portion of chronic pain sufferers may be left untreated, only a small portion of primary care physicians have had formal training in pain management. Thus providers with a primary care background are especially in need of basic education about chronic pain. Further studies are needed to evaluate any impact of this formal training on patients' symptoms and outcomes and to assess the adequacy of chronic pain management in primary care.

The majority of participants who are eligible do not currently have a prescription for an opioid. Therefore, they should be recruited for RCTs investigating clinical treatments for chronic pain but be less concerned than current trials of obtaining detailed information on baseline characteristics.

Goals intervention demonstrated short- and long-term benefits when added to traditional care in patients with chronic pain. Further large-scale, multicenter studies are urgently required to address the efficacy of goal-based interventions for chronic pain.