IASP Curriculum Outline for Pain in Social Work

Task Force Members: Terry Altilio (Co-chair, USA), John Cagle (USA), Kerryn Coombe (Australia), Maris Pasquale Doran (Co-Chair, USA), Andy Sim Gim Hong (Singapore), Jody Kohn (USA), Isac Tsambe (Mozambique)

Outline Summary

Introduction
Principles
Objectives
Curriculum Content Outline

I. Multidimensional Nature of Pain
II. Pain Assessment and Measurement
III. Management of Pain
IV. Clinical Conditions

References

Introduction

The social work discipline has historically employed a biopsychosocial, strengths-based approach of assessing a person within the environment and honoring the subjective report of experience. These values are a fundamental platform upon which social workers can build skills to attend to the social, cultural, political, ethical, psychological and spiritual aspects of pain both as a societal issue and individual challenge. Comprehensive assessment of pain is individualized, patient and family-centered, and multidimensional.

Principles

Pain is a multidimensional issue encompassing physical, emotional, cognitive, behavioral, spiritual, cultural and interpersonal layers. Social workers who develop pain-specific knowledge are better able to assess and advocate for appropriate care and employ evidence-based interventions that contribute to the team management of pain and related suffering. The multiple facets that converge around pain are relevant for social work intervention whether at the level of clinical care, research, policy, ethical analysis, advocacy, or education. Pain represents a health problem demanding social work attention and advocacy, as the profession’s commitment to social justice is a value challenged by lack of access to comprehensive pain treatment and professional expertise, a reality compounded for underserved and vulnerable populations.

Objectives

Social workers at the end of this entry-level pain curriculum will be able to:

  1. Discuss the role of social workers to function as advocates, care managers, clinicians, educators and coordinators of treatment plans for persons living with pain, including preventing the behavioral and social consequences of unrelieved pain. 
  2. Demonstrate a basic understanding of the mechanisms and types of pain
  3. Describe barriers to the reporting and management of pain and the consequences of unrelieved pain on individuals, families, and society
  4. Demonstrate familiarity with screening and assessment tools and evidence-informed interventions 
  5. Discuss how the social work discipline’s historical commitment to vulnerable populations, social justice, and to the relief of suffering apply to the under treatment of pain
  6. Identify the myriad factors that contribute to a person’s pain experience and how these factors influence an individual’s and family’s response and inform interventions 
  7. Demonstrate an understanding of the complex regulatory climate surrounding opioid medications, including the impact of medication diversion, global access, and prescribing practices for persons living with pain
  8. Identify and address ethically-challenging situations that undermine an individual’s ability to self-determine about the level of care received and his or her ability to access adequate pain and symptom management and relief
  9. Promote effective and culturally sensitive communication processes amongst healthcare providers and patients and their families 
  10. Recognize and influence the ethical discernment and decision-making processes that inform public policy and treatment of persons living with pain

 

Curriculum Content Outline (entry-level, pre-licensure)

I. Multidimensional Nature of Pain

a. Epidemiology

i. Prevalence of pain
ii. Impact of pain on individual, family, society
iii. Pain disparities

b. Definitions

i. Pain
ii. Acute
iii. Persistent (Chronic)
iv. Breakthrough
v. Pain in serious illness
vi. Suffering

c. Types

i. Nociceptive (somatic, visceral)
ii. Neuropathic

d. Dimensions of pain experience and suffering

i. Physical/sensory
ii. Cognitive
iii. Behavioral

1. Pain-related disability

iv. Affective

1. Interrelationship of pain, depression, and anxiety

v. Cultural
vi. Social
vii. Familial
viii. Spiritual

e. Ethical principles

i. Access to care

1. Political, policy, public health, and regulatory factors

ii. Advocacy

1. Global and national initiatives (e.g. IASP Declaration of Montreal, US Joint Commission Pain Management Standards)

iii. Right of patient to appropriate assessment and pain treatment
iv. Principles of biomedical ethics

II. Pain Assessment and Measurement
a. Common pain scales

i. Visual analogue, numerical and categorical scales
ii. Pictorial scales and body charts
iii. McGill pain questionnaire
iv. Brief pain inventory
v. Daily function and activity interference scales
vi. Psychological scales (e.g. Mood, Pain Catastrophizing Scale)

b. Assessment of pain

i. Patient report and clinician’s valuing of subjective experience
ii. Pain quality descriptors (e.g. burning, shooting, stabbing)
iii. Non-verbal pain behaviors (e.g. guarding, grimacing)
iv. Behaviors of patient; responses of family and social network
v. Impact on self: self-concept, mood, sleep, social roles and isolation, sexuality
vi. Impact on family: communication, roles and structure, finances
vii. Coping styles
viii. Age and gender differences and role of individual differences
ix. Cultural variables impacting reports (e.g. stoicism)
x. Impact of pain on attention and processing information
xi. History of pain experiences and current impact (personal, familial, cultural, spiritual)

c. Social work focus on biopsychosocial assessment of person in environment as basis for understanding pain experience & framing interventions
d. Biomedical focus on diagnosis and treatment vs. understanding the attributed meaning and experience for person and intimate network

III. Management of Pain

a. Basic medical & pharmacologic management

i. Pain medication
ii. Procedural interventions
iii. Care coordination

1. Primary care
2. Community supports
3. Mental health resources

b. Barriers to adequate pain management

i. Practical challenges (e.g. cost, availability, educated professionals)
ii. Clinician biases emanating from cultural and racial differences
iii. Cultural, family, and personal values and fears (e.g. stoicism, fear of being a burden, stigmatization)
iv. Impact of provider’s cultural values and beliefs on patient care
v. Opioid related concerns of patients and families

1. Inadequate education about communicating pain and treatment effects
2. Stigma associated with pain medications
3. Concerns related to fears of addiction
4. Concerns about adverse effects
5. Fear of developing tolerance
6. Fear of overdose

vi. Political, policy, public health, and regulatory factors
vii. Addiction History

1. Personal history and screening
2. Risks of medication misuse or diversion

viii. Fatalism
ix. Untreated and undertreated pain

1. Vulnerable populations: women, children, older adults, poor and underprivileged, minority racial and ethnic groups, individuals with substance abuse history, individuals with psychiatric illness, individuals who are non-verbal, individuals who are terminally ill
2. Access to pain-specialized care

a. Financial and insurance barriers
b. Remote and rural areas
c. Lack of integrated healthcare systems

c. Skills and strategies to enhance pain relief, self-efficacy, and outcomes

i. Education
ii. Improving adherence to a pain management treatment plan
iii. Motivational interviewing
iv. Self-management strategies and tools
v. Relaxation
vi. Breathing exercises
vii. Pacing & goal setting
viii. Journals and diaries (e.g. paper or electronic monitoring of symptoms, emotional and cognitive responses)
ix. Problem solving
x. Acceptance

d. Pain accompanied by change in employment, social and family role, ADLs, recreation, sleep, sexuality

i. Identify resources
ii. Teach skills to mediate the effects of life changes

e. Empowering

i. Assist in redefinition of sense of self to encourage continued engagement in life
ii. Intervene to enhance self-efficacy and self-determination
iii. Mediate culturally-sensitive communication between patient, family, and healthcare providers
iv. Use of interpreters when first language of provider and patient are different

f. Family focused interventions

i. Address impact on familial roles and equilibrium, communication patterns, sexuality, finances
ii. Integrate respect for cultural values in decision making and treatment plans

g. Group-focused interventions to reduce isolation, share strategies, sources of meaning, enhance motivation
h. Evidence based mind-body interventions

i. Cognitive therapies (e.g. CBT, ACT, MBCT)

1. Addressing maladaptive beliefs

ii. Biofeedback
iii. Guided imagery
iv. Mindful meditation
v. Relaxation Therapy
vi. Hypnosis

IV. Clinical Conditions
a. Acute pain associated with trauma, surgery, or acute medical conditions
b. Common chronic pain conditions associated with illness such as chronic obstructive pulmonary disease (COPD), end-stage renal disease, dementia, arthritis, and cancer
c. Relationship of somatic and psychological factors in chronic pain
d. Comorbidity of chronic pain and mental health diagnoses
e. Management of pain in setting of disease of addiction

References

Altilio, T., & Doran, M.P. (2013). Pain. Encyclopedia of Social Work. Retrieved from http://socialwork.oxfordre.com/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-276

Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., et al. (2003). The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Medicine, 4(3), 277–294.

Lasch, K.E. (2002). Pain clinical updates: Culture and pain. International Association for the Study of Pain, 10(5).

Mendenhall, M. (2003). Psychosocial aspects of pain management: A conceptual framework for social workers on pain management teams. Social Work in Healthcare, 36(4), 35-51.

Otis-Green, S., Lucas, S., Spolum, M., Ferrell, B., & Grant, M. (2008). Promoting excellence in pain management and palliative care for social workers. Journal of Social Work in End-of-Life & Palliative Care, 4(2), 120-134.