Self-Management and the National Pain Strategy

Self-Management and the National Pain Strategy

By Beth Darnall, PhD

Dr. Beth Darnall

Dr. Beth Darnall

I caught up with Dr. Kate Lorig to learn about what the National Pain Strategy means for self-management and pain care in the U.S.  

The 2016 National Pain Strategy has placed self-management firmly in the spotlight as a critical pathway to better treat pain in the U.S.

Cue Dr. Kate Lorig, the Godmother of Self-Management. Dr. Lorig spearheaded the development of self-management education and treatment at Stanford University 3 decades ago, beginning with the Arthritis Self-Management Program. She and colleagues studied participant outcomes for her program and demonstrated some of the best results for any behavioral or educational intervention — doubly impressive due to their incredible durability. Randomized controlled trials show that self-management programs confer improvements in self-efficacy and health status — improvements that are sustained at 4 year follow-up (Lorig KR et al 1993). What’s more, similar results are found for the internet-based adaptations of her programs across various pain conditions, including rheumatoid arthritis, osteoarthritis, and fibromyalgia (Lorig KR et al 2008).

Dr. Kate Lorig

Dr. Kate Lorig

What started out as self-management for arthritis has been expanded to HIV, cancer, chronic disease, and diabetes. All of the self-management programs teach participants how to help themselves become more active, manage symptoms, and problem solve effectively. Self-management is all about engaging patients in their own care (click here to learn more about self-management). Her programs are available in every state in the U.S. and in about 30 countries worldwide. They are offered widely in the US in Spanish and English and around the world in 20 different languages. In short, thirty years ago Dr. Lorig began a self-management movement that has literally changed the world.

All of Dr. Lorig’s self-management programs have a component of pain education and self-management of pain.

Unsurprisingly, the National Pain Strategy includes language about the need to systematically integrate self-management into pain care.

I took the opportunity to sit down with Dr. Kate Lorig and hear in her own words what this all means.

This is very exciting 30 years ago we started with self-management for arthritis. In fact my first peer reviewed paper focused on how both patients and rheumatologists viewed arthritis pain. We conducted numerous randomized trials on the effectiveness of community based self-management programs for arthritis, pain, and co-morbid chronic conditions.

People live 99 percent of their time outside of direct medical care. What they do during this time greatly determines their pain, their quality life and also their utilization of the health care system. To live this time most effectively, patients must learn self-management skills, and have the confidence to practice these skills on a day to day basis. Our research has shown us that patient confidence of the key to successful self-management. Fortunately, with carefully crafted programs with emphasis on action planning, modeling and reinterpretation of symptoms, confidence can be enhanced and in turn improve self-management. Over the years we have conducted many randomized trials and found that people attending our programs have less pain,  and less depression, are more active and utilize few health services than usual care controls. We now have more than a million people who have taken our community based or Internet based programs. These programs are usually free or low cost and in a few places are covered by third party insurers.

With the endorsement of self-management by the National Pain Strategy — what are the implications?

It means making changes for both patients and providers. For patients it means that they sometimes have to change the way they think about pain. We tend to think that when we are not feeling well, we can go to the doctor and get fixed. Unfortunately, for most people with pain this is not possible. For providers it means that they may have to think beyond the traditional treatments of medicine, surgery and physical therapy. Treatment for pain is not usually passive, it takes active participation of both provider and patient and the patient must learn the skills and gain the confidence to be an effective self-manager. This cannot be done in a few minutes.  Rather these are gained over time in a structured setting. For pain, self-management will continue to be a central part of pain management.

What does it mean for your work, and the work of your group? 

We will continue to spread our programs and hope to also develop an Internet based pain self-management program. We are in the best of all worlds for doing this. At Stanford we are part of the division of Rheumatology (arthritis) and also have an excellent working relationship with the Stanford Pain Management Center.

What’s the most exciting thing on your horizon at the moment?

With the National Pain Strategy we stand ready to work with our pain partners to expand our programs and to forming new partnerships with health care providers. We will also release a Spanish pain self-management program later this year.

To find a program near you go to Look for the Pain self-management or the chronic disease self-management program.

Read the final report of the National Pain Strategy here.

This article is simultaneously posted on Beth’s blog at

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Tim Mason, What was the options left for you after all this failed? Did you still have any options for riddding or at least lowering your pain? Were you refused pain meds like the rest of us, or being weaned off completely like me.
I think this new pain treatment is criminal. I seriously s[my think I can live without pain meds. I have multiple problems that cause me pain.

Tim Mason

My self management check list for 2016 (wait for it)
After going back to my neurosurgeon with low back pain again (post 2014 fusion) I find out I have an extruded disc (Bi-lateral) at the L4-L5 level compressing both exiting nerve roots + scar tissue encasing S1 descending nerve. Bear in mind I needed the image and simultaneously my pain doc’s PA said I needed a spinal stimulator.
My “self-management” consisted of 33 physical therapy visits at a top of the line hospital affiliated Facility: I did the following as requested:
Bought two McKenzie half roll chair supports-
Bought a foam roller to work on my muscles and right angry buttock (piriformis)
Bought a Miracle stretcher for piriformis muscle
Bought top of the line adjustable bed
Changed my posture while walking/setting. (even while working)
Changed the way I get in and out of bed.
Went to the fitness center at physical therapy place.
received clinical massage.
After doing all the above I am only able to add 1 hour to my work day. I still cannot walk due to the pain in my back and buttock.
I spent a great deal of money and so did my insurance company to do this. Most people cannot afford to do what I did.
The self management protocols can get quite expensive and do little if anything (perhaps more damage as in my case)
My self management has led me to require a lumbar CT.

Mark Ibsen MD

There was a self management program in our state:
Medical marijuana.
The decimation of this program has created more, not less dependence, by design.
May I say this:
Self management is a process of discovery. Self discovery.
Utilized as a bludgeon
It will fail in the same time way meditation can fail: if the patient embraces ut, fine,
Otherwise it occurs to them as another way to be blamed it made wrong.


Nothing like promoting an underpowered occupational strategy and calling it the public good and for the good of individuals in pain. Its no wonder no mention is made if the self management programs were well received by people in pain- or that they were even asked for by people in pain.
Self- management programs reflect the fatalism and failure of pain specialists. They wish to impose pre-defined medicocentric values and beliefs on to people in pain- with or without the consent of the person in pain. They assume no one with rheumatoid arthritis can become pain free- I guess they don’t read the same studies as I do- because research shows people with rheumatoid arthritis can become pain free.
When I was in pain I would have criticized any provider who mentioned management of my pain- I was fortunate enough that none of them opposed my wanting to be pain free- and today and for 16 years I am pain free. Intention matters-if youre promoting that people in pain can only manage their pain-then youre unlikely to help them become pain free and disease free.
I guess promoting “pain management” is a way for the health care industry to set standards low for pain care. People in pain should reject such low standards and call for health care to have much higher standard of care.


It will be interesting to see how this all pans out. My hope is that the NPS will not drag its feet — we need these programs.