Prehabilitation: The underutilised weapon for chronic pain management

Abstract

Objective: Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to 'prehabilitate' patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions.

Methods: Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed.

Results: Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention.

Conclusions: Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.

Keywords: Chronic pain; pain management; personalised care; prehabilitation; psychological preparation.

Figure 1.

The interrelating psychological constructs influencing behavioural engagement for pain management. Note. Patient expectations, pain catastrophizing, self-efficacy and health locus of control (HLOC) are all independently associated with behavioural engagement with self-management and treatment completion or attrition.^,,,, Negative expectations are associated with higher pain catastrophizing. Pain catastrophizing has a negative relationship with self-efficacy; higher levels of pain catastrophizing are negatively correlated with lower self-efficacy. Self-efficacy and health-related locus of control are directly associated ; high levels of internal HLOC are positively correlated with high pain self-efficacy, having greater behavioural engagement in pain self-management strategies.