Acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to treat it. Chronic pain, however, persists. Pain signals keep firing in the nervous system for weeks, months, or even years. According to the National Institutes of Health, there may have been an initial mishap -- sprained back, serious infection, or an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage. Many chronic pain conditions affect older adults. Common complaints of chronic pain include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), and psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system).

People do a number of things in attempting to control pain. Pain coping skills training been shown to produce immediate improvements in pain and disability in rheumatoid arthritis. However, some patients have difficulty maintaining these gains. A study by Carson, Frank Keefe, and their colleagues compared a convention coping skills training approach with a similar approach that also included maintenance training. Patients with arthritis (n = 167) were randomly assigned to either conventional pain coping skills training, pain coping skills training plus maintenance, arthritis education control, or usual care control. Data were collected daily on joint pain, coping, coping efficacy, and mood. Analyses following treatment showed pain coping skills training was superior to all other conditions in joint pain, coping efficacy, and negative mood, whereas similar training plus maintenance was superior to all other conditions in emotion-focused coping and positive mood. At the 18 months follow-up, both pain coping skills training conditions were superior to standard care in joint pain and coping efficacy.

COMMENTS: There was a high dropout rate in both of the coping skills groups, thus suggesting that the maintenance component did not appear to produce significant improvements over conventional coping skills training. We have no idea the extent to which self-efficacy was emphasized in the program. Had that been a major component of the coping skills program, different results might have been obtained in the maintenance of these skills. This suggestion is based upon the findings of Kate Lorig and her colleagues in maintaining self-management skills in patients with arthritis. However, despite this possible shortcoming, this was still an excellent study.

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J.W. Carson, F.J. Keefe et al. A comparison of conventional pain coping skills training and pain coping skills training with a maintenance training component: a daily diary analysis of short- and long-term treatment effects. Journal of Pain, 2006;7:615-625.