Helping patients with chronic pain to set management goals

Management goals for chronic pain are developed in collaboration with the patient using a multidimensional approach. Functional improvement is the primary goal and pain reduction is secondary.

Encourage patients (adults and children) to set SMART (ie specific, measurable, achievable, realistic, and time-contingent) goals. For example, ‘Be able to walk around the park, once per week for 40 minutes, within 2 months from now’. When setting SMART goals, always consider activity scheduling and pacing to prevent overexertion (causing pain) followed by inactivity. Children and adolescents may need their parent’s or carer’s advice to make SMART goals suitable to their family environment.

Encourage the patient to make at least one management goal in each of the focus areas—see Examples of chronic pain management goals for examples of focus areas and appropriate goals for different age groups. Goals should be personally meaningful for the individual patient.

Table 1. Examples of chronic pain management goals
[NB1]
Focus area	Youth	Adult	Aged
Vocation	attend school full-time within 4 weeks	return to work	mind my grandkids after school 2 days per week
Social connection (other than online)	go to the movies with my friends	go back to coaching soccer	go to Men’s Shed once a week
Emotions and thoughts	practise mindfulness with ‘Smiling Mind’ app every day	increase awareness of thought patterns through mindfulness practice	increase awareness of emotions through mindfulness practice
Physical	walk without crutches before the school dance	begin a gentle strength program at the gym	do ‘sit-to-stand repeats’ before each meal
Sleep	do my sleep preparation routine and avoid electronic devices 1 hour before bedtime	avoid electronic devices 1 hour before bedtime	get up at a set time each morning
Nutrition	cut out soft-drinks	eat more vegetables	eat less packaged food
Pain	pace myself so my pain score stays at or below 6/10	achieve a meaningful reduction in pain over the next 3 months	avoid triggering pain flares
Note: NB1: Management goals should be personally meaningful for the individual patient and developed into SMART (ie specific, measurable, achievable, realistic, and time-contingent) goals.

Some patients will feel overwhelmed if asked to set multiple goals concurrently. Help the patient to prioritise management goals and consider staggering work on each goal.

If a trial with analgesia is required, set goals and expectations for the expected efficacy and intended duration of use. At the time of analgesic initiation, discuss the plan for deprescribing; see The role of analgesics in chronic noncancer pain for further advice.