Mini-Science 2012 Q&A: “Helping people with pain resume occupational involvement”

Mini-Science logoAt the conclusion of each Mini-Science lecture, audience members submit their questions to the evening’s presenter, who answers as many as possible on the spot. Some of the best questions are posted here. Here are questions from Dr. Michael Sullivan’s April 25 talk, “Helping people with pain resume occupational involvement.”

Q: Does completion of PGAP result not only in more people returning to work, but people going to work with a more positive attitude toward life? Is this behavior modification? (PGAP is the acronym for the Progressive Goal Attainment Program, the first community-based intervention program designed specifically to target psychosocial risk factors for pain-related disability and developed by Dr. Sullivan’s team in the early 2000s.)

A: We don’t have data on people’s attitudes toward life after PGAP, but we do have data suggesting that participation in PGAP leads to reductions in pain and depression, and increases in quality of life.

The program would not really be considered behaviour modification. Behaviour modifications programs are typically based on learning principles, and the goal of intervention techniques is to modify reinforcement contingencies to increase or decrease the frequency of target behaviours. In PGAP, the objective is to strategically change the client’s activity participation such that the client will be more likely to be exposed to success and achievement experiences, and derive a greater sense of meaning and purpose from these activities.

Q: Who are the PGAP team members? Is it only psychologists?

A: The health disciplines that have been trained to be PGAP providers include (in order of prevalence) occupational therapists, physical therapists, occupational health nurses, psychologists, chiropractors, and physicians.

Q: Should a patient who already exhibits the psychosocial factors you discussed (fear, catastrophizing, etc.) undergo an elective procedure like a joint replacement?

A: We recently received a grant from the Canadian Institutes of Health Research (CIHR) to conduct a study examining whether an intervention designed to reduce pain-related psychosocial risk factors might improve surgical outcomes. I don’t think we want to be in a position where we would withhold medical treatment for individuals who show a psychosocial risk profile. However, if we can identify psychosocial risk factors for problematic recovery, we should see if there are ways in which we can reduce these psychosocial barriers in order to augment the impact of our medical interventions. For example, severe pain is a central clinical management issue in palliative care. Research tells us that high catastrophizers benefit less from pain medication, which likely translates into increased suffering for these individuals. Catastrophizing-reduction techniques could be usefully incorporated into palliative care approaches in order to maximize the benefit that patients will derive from their pain treatment.

Please visit the Mini-Science website for more information about the lecture series.

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