Breaking Barriers: The Progressive Goal Attainment Program for Chronic Pain Management
Here’s a fun fact.
Pain management was first recognised as a field in the 1960s.
In the 1970s, it had a dedicated journal ‘Pain’ and an association to its name. Soon after, the medical fraternity realised that a multidisciplinary team was important.
Since then, multiple advancements have been made in the field of pain management.
In 2021, the definition was changed for the first time since 1979 by the International Association for the Study of Pain in the hopes that it would lead to revised ways of assessing pain. You can read it here.
Several studies over the last three decades have thrown light on the importance of psychosocial factors in chronic pain management.And yet. Aside from research, psychosocial and mental health factors are largely overlooked in the treatment of chronic pain.
In our episode with Dr. Michael Sullivan, we talk about the miles we’ve still got to cover, in effective pain treatment.
Introduction to PGAP and its Interventions
In 2000, Sullivan developed the Progressive Goal Attainment Program (PGAP) largely to make access to pain management easier for people. PGAP is a psychological intervention designed to be time-bound and goal-oriented. It focuses on psychosocial risk factors that impact success of pain treatment interventions.
Part of the intervention are multiple tools that he and his team have developed that help to address psychosocial risk factors. These tools include:
-
The Pain Catastrophizing Scale (PCS) - Pain catastrophizing has been broadly defined as an ‘exaggerated negative mental set brought to bear during actual or anticipated experience of pain’. The Pain Catastrophizing Scale (PCS) was developed as part of this program of research.
-
The Injustice Experiences Questionnaire (IEQ) - Two studies show that perceptions of injustice following an injury lead to prolonged occupational disability heightened mental health issues.
-
The Perceived Deficits Questionnaire (PDQ) This measures cognitive dysfunction in people with prolonged pain. A higher score indicates longer treatment times and higher risk of injury. Cognitive dysfunction affects many people who suffer from chronic pain and this questionnaire assesses the degree to which mental and physical pain affects memory, cognition, and function.
In 2006, a paper titled, ‘A psychosocial risk factor--targeted intervention for the prevention of chronic pain and disability following whiplash injury’ found that, “Participation in PGAP plus physical therapy resulted in a higher return-to-work rate (75%) than participation in physical therapy alone (50%)”
The tricky part comes to the “when” of it.
The intervention is designed so that anyone can implement the tools as part of their treatment approach. Sullivan cautions against a protectionist approach and calls for a multi-disciplinary approach in incorporating psychological approaches in the first line of intervention. To hear more about how one can do that, listen to the full interview.
Addressing gaps between assessment, intervention, and effective policies
Dr. Sullivan remembers asking how many people had used the Pain Catastrophizing scale in a room full of people at a conference a few years ago. “And how many of you developed an intervention for it?”, he follows up and only a few hands stay up.
Implementing an evidence-based intervention successfully across multiple levels of state, insurance, and hospital systems is difficult but can be done. In the episode, he talks about a multi-year project that went deep into all levels of the organisation and is still running successfully years later.
“There is a tendency to look for an easy fix”, he muses. But, the ground reality is that there isn’t one. There are multiple worlds and systems that come into play in effective management of chronic pain and to integrate a new approach until it soaks through all those levels is not easy and takes time. “But it really is doable”, he goes on to emphasise.
But Dr. Sullivan and his team are out there to turn that into a reality.
To listen to the full episode, go here.
You can also find it on Apple Podcasts, Spotify, Google, and wherever else you find your podcasts.
At PREMUS, WDPI, & MYOPAIN 2023, Dr. Michael Sullivan is giving a keynote lecture on The Psychology of Pain: Implications for Practice and Policy
He is also doing a Symposium on Perceived Injustice and Delayed Recovery: Treatment Implications and Applications Michael Sullivan, Heather Adams, Junie Carriere
And Progressive Goal Attainment Program: A Risk-Targeted Intervention to Reduce Psychosocial Barriers to Occupational Re-Integration Michael Sullivan
Breaking Barriers: The Progressive Goal Attainment Program for Chronic Pain Management
Here’s a fun fact.
Pain management was first recognised as a field in the 1960s.
In the 1970s, it had a dedicated journal ‘Pain’ and an association to its name.
Soon after, the medical fraternity realised that a multidisciplinary team was important.
Since then, multiple advancements have been made in the field of pain management.
In 2021, the definition was changed for the first time since 1979 by the International Association for the Study of Pain in the hopes that it would lead to revised ways of assessing pain.
You can read it here.
Several studies over the last three decades have thrown light on the importance of psychosocial factors in chronic pain management.
And yet. Aside from research, psychosocial and mental health factors are largely overlooked in the treatment of chronic pain.
In our episode with Dr. Michael Sullivan, we talk about the miles we’ve still got to cover, in effective pain treatment.
Introduction to PGAP and its Interventions
In 2000, Sullivan developed the Progressive Goal Attainment Program (PGAP) largely to make access to pain management easier for people. PGAP is a psychological intervention designed to be time-bound and goal-oriented. It focuses on psychosocial risk factors that impact success of pain treatment interventions.
Part of the intervention are multiple tools that he and his team have developed that help to address psychosocial risk factors. These tools include:
-
The Pain Catastrophizing Scale (PCS) - Pain catastrophizing has been broadly defined as an ‘exaggerated negative mental set brought to bear during actual or anticipated experience of pain’. The Pain Catastrophizing Scale (PCS) was developed as part of this program of research.
-
The Injustice Experiences Questionnaire (IEQ) - Two studies show that perceptions of injustice following an injury lead to prolonged occupational disability heightened mental health issues.
-
The Perceived Deficits Questionnaire (PDQ) This measures cognitive dysfunction in people with prolonged pain. A higher score indicates longer treatment times and higher risk of injury. Cognitive dysfunction affects many people who suffer from chronic pain and this questionnaire assesses the degree to which mental and physical pain affects memory, cognition, and function.
In 2006, a paper titled, ‘A psychosocial risk factor--targeted intervention for the prevention of chronic pain and disability following whiplash injury’ found that, “Participation in PGAP plus physical therapy resulted in a higher return-to-work rate (75%) than participation in physical therapy alone (50%)”
The tricky part comes to the “when” of it.
The intervention is designed so that anyone can implement the tools as part of their treatment approach. Sullivan cautions against a protectionist approach and calls for a multi-disciplinary approach in incorporating psychological approaches in the first line of intervention. To hear more about how one can do that, listen to the full interview.