Group Therapy in Pain Management

Group Therapy in Pain Management

Pain patients frequently show signs of emotional distress, with evidence of depression, anxiety, and irritability. Group therapy with a cognitive/behavioral orientation is designed to help patients gain control of the emotional reactions associated with chronic pain. Specific problem-solving strategies offered during group therapy sessions include 1) identifying maladaptive and negative thoughts, 2) disputing irrational thinking, 3) constructing and repeating positive self-statements, 4) learning distraction techniques, 5) working to prevent future catastrophizing, and 6) examining ways to increase social support. In addition, group therapy presents an opportunity to discuss concerns or problems that patients have in common. Unlike psychotherapists in traditional group sessions, group therapists in a pain management program are encouraged to be active facilitators. They may need to redirect the discussion so that every member has an opportunity to speak and no one individual monopolizes the session. Participants should also be offered individual therapy sessions in which to deal with individual issues.

Certain group members may initially be reluctant to discuss personal problems related to their pain. The group therapist must promote a comfortable atmosphere, preventing other participants from being judgmental or negative. The idea must be conveyed that people are there to learn from one another and to support one another in gaining control over pain. Individuals who display negative pain behaviors (e.g., moaning, sighing, grimacing, resting their head on the table, lying on the floor, or arriving late or leaving early without adequate explanation) should be asked to meet with their case manager to determine whether this behavior can be changed. To maintain a positive group atmosphere, it may be necessary to ask participants who exhibit excessive negative behaviors to leave.

Group and room size. An optimal number of people for group therapy is 6 to 8. Larger groups make control of conversation difficult, while participants in smaller groups do not have adequate opportunities for interaction with others. Attention should be paid to the arrangement of the room. Some chairs are particularly uncomfortable for persons with chronic pain. Ideally, the chairs should have arms with suitable cushioning and back support. Chairs that are either very hard or very soft are not appropriate. Chairs that are too low to the ground make it difficult to get up and down. Minimal requirements for a meeting room include privacy, comfortable chairs, ample space, wheelchair (and possibly stretcher) accessibility, a drawing board, and easy access to restrooms and water. Optional equipment includes a VCR, an overhead projector, a slide projector, and a screen.

Unlike traditionally run psychotherapy groups, pain management therapy groups need to be focused and structured. Members need to be aware that the program is time-limited and that the raising of issues beyond the scope of pain-related concerns may not be appropriate. When pain patients get together, there is always the risk that the discussion will degenerate into griping and grumbling. Each patient may feel that his or her "war story" is the most tragic. Excessive complaining often leads to the group¹s deterioration and may cause some members to drop out. Although sharing common experiences is important, most group members reach a point when they no longer want to hear about problems but instead want to focus on solutions. The best therapist will allow for open sharing of information, but will step in when anyone monopolizes the conversation by repeatedly recounting their personal problems.

Group format. The group format should be discussed openly at the beginning of the program and again at the start of each session. It is useful for the therapist to outline for the group what they can expect to accomplish at the session. In large groups, all members should have an opportunity to up date their situation, including recent events in their lives and successes in combating their pain. Those persons who need more time to share a particularly distressing experience should be offered individual therapy. Individuals who are intolerant of other group members or who are consistently disruptive should be asked to leave.

Family Therapy

Chronic pain significantly impacts all members of a family. Family members need to be educated about the goals of therapy and should have an opportunity to share their concerns. Moreover, active involvement of family members helps ensure the patient's long-term success. Therefore, both patients and members of their families should be invited to attend family therapy sessions. At these sessions, the facilitator should encourage family members to ask questions about the pain management program, to discuss their concerns and expectations, and to express their feelings. Besides enhanced communication, important outcomes of these sessions are that family members learn how to help the person in pain achieve and maintain goals and that they come to understand that they are not alone in dealing with that person. It is best to schedule one family therapy session at the start and another at the end of the structured program.

This article was excerpted from the book Mastering Chronic Pain: A Professional's Guide to Behavioral Treatment. by BW Pain Management Center physician Dr. Robert N. Jamison, Ph.D., published by Professional Resource Press, Sarasota, FL, 1996.