Motivating a person to change can be a challenge, especially when working with an injured worker who has developed an identity based on having disabling chronic pain. With the CDC’s recently released opioid guidelines warning of the dangers of long term use, more physicians and other healthcare workers are pushing to wean patients off pain medications and change treatments that have been a foundation in a person’s disabled identity. As healthcare professionals begin to realize the necessity for a change in treatment practices, it is the patient who must ultimately make the change. But how can case managers and clinicians motivate the person to do so?

More Than a Simple Request

Understanding change goes well beyond simply asking a person if they are willing to do something different. What is being asked of him is to change his way of thinking about himself and his chronic pain. Significant psychosocial obstacles will challenge him to accept that such a request is even possible.

Paradigm Outcomes’ history of managing thousands of cases has confirmed that the biopsychosocial approach is the best way to manage chronic pain. Opioid reduction or elimination is often an evidence-based medical best practice, but getting an injured worker to even contemplate life without narcotics and to adopt other strategies to effectively manage their pain is a real challenge. The first step is to identify where a person is in relation to their willingness to make the necessary changes.

Stages of Change

Paradigm uses the Transtheoretical Model to identify where a person fits into the continuum of change.  The injured worker can be identified in one of 5 Stages of Change.

• Precontemplative: Not willing to make a change
• Contemplative: Thinking about making a change
• Preparation: Getting ready to change
• Action: Actively participating in this change
• Maintenance: Maintain this change over time

Paradigm partnered with the renowned health behavior researcher and founder of the Transtheoretical Model, Dr. James O. Prochaska, and his organization to develop specific strategies and techniques to assist moving an injured worker with chronic pain and opioid use disorder through these stages. Our care management teams use the model to make treatment adjustments and apply evidence-based pain management medical care to wean the injured person off narcotics, restore function and ultimately reach self-management and reliance.

When an injured worker adopts these approaches to pain management, a more positive and durable recovery plan can be secured; one that follows the biopsychosocial model for the management of chronic pain.

To learn more strategies for complex pain case management, visit our webinar archive or follow us on Facebook, Twitter, and LinkedIn.

About the Authors
Bill McAweeney is the Associate Vice President of Clinical Services for the pain management division.  He has been with Paradigm Outcomes for 17 years, initially in the role of Director of Clinical Services for catastrophic injury management. He oversees, and played a primary role in the development and execution of, the clinical operations for Paradigm’s pain management program. Bill has more than 25 years of catastrophic injury clinical and rehabilitation program management experience. He earned his master’s degree from the University of Wisconsin, Madison, in rehabilitation counseling psychology.

Jennifer Doherty OTR/L, CCM, CLCP, MSCC is a Director of Clinical Services for pain operations. In her role, Jennifer’s goals for every file are excellent clinical outcomes and improvement in claims disposition. She brings her expertise as a former Medicare Set-Aside allocator and Life Care Planner to identify cost drivers and assist in posturing the file for settlement where available.