Agreat deal of research now supports the conclusion
that how well patients manage chronic pain
depends more on what they do than on what is
done to them; most of the “work” of chronic pain management
is done by the patient. For example, in cognitive-
behavioral and multidisciplinary pain treatment, patients
learn and then use self-management skills to
control pain and its effects on their lives.14,49,94 Inevitably,
this involves asking patients to make significant
changes in their behavior. Patients are taught to remain
active, to exercise regularly, and to increase activity tolerance,
even when they experience short-term increases
in pain. Typically, they acquire and are expected to apply
multiple pain coping skills, such as activity pacing, relaxation,
and cognitive restructuring. Other behavioral
changes are also sometimes required. For example, those
for whom excess weight contributes to pain and disability
(eg, obese patients with knee osteoarthritis or low
back pain) might also be asked to change long-established
eating habits.