La prise en charge cognitivo-comportementale de la douleur chronique présente des résultats fort encourageants au regard des bienfaits à la fois physiques, fonctionnels et psychologiques qu’elle contribue à générer chez les patients en bénéficiant. Ce mode de traitement non médicamenteux est en partie basé sur l’acquisition de nouvelles stratégies adaptatives visant à aider les patients à gérer plus efficacement leurs douleurs. Or, de nombreux échecs thérapeutiques sont directement imputables aux difficultés à initier et faire perdurer les changements indispensables à la poursuite des objectifs thérapeutiques fixés. La disposition au changement pourrait jouer à ce titre un rôle considérable dans la réussite ou non de la prise en charge. L’objectif principal de cet article est donc de présenter les données de la littérature actuelle portant sur les spécificités du processus de changement dans le champ de la douleur chronique. Nous décrivons dans un premier temps le cheminement psychologique emprunté par les patients douloureux chroniques aspirant à mieux gérer leur souffrance via le modèle transthéorique du changement intentionnel. Dans un second temps, nous développons les apports de la technique de l’entretien motivationnel dans l’amélioration de la prise en charge de la douleur chronique.

Cognitive and behavioral approach of chronic pain presents encouraging results by improving physical, functional and psychological states of chronic pain patients. This specific treatment is partially based on the acquisition of new adaptive strategies to help the patients to manage more effectively chronic pain and to improve subsequently their subjective well-being. This requires in parallel to give up noxious emotional, cognitive and behavioral attitudes towards pain. Now, we have to admit that numerous therapeutic failures are directly imputable to difficulties introducing and making the indispensable changes continue in pursuit of the fixed therapeutic objectives. Readiness to change could play a considerable role in the success or not of chronic pain treatment. The main objective of this article is to present the data of the current literature concerning the specificities of the process of change in the field of the chronic pain.

We present a review of the literature describing at first, the psychological progress made by chronic pain patients longing to manage their suffering better via the trans-theoretical model of intentional change. Secondly, we develop the contributions of the technique of motivational interviewing in the improvement of chronic pain treatment.

The identification of the motivational profile of chronic pain patients will determine how motivational interviewing can be conducted to improve their readiness for change. There are several strategies used with chronic pain patients in pre-contemplative and contemplative stages. Therapists may facilitate the problem recognition (help chronic pain patients to become aware of and identify the nature of the difficulties they face when trying to cope with their physical suffering); increase the personal concern (empowering chronic pain patients so that they feel fully involved in what they offer and invest in the therapy); develop the intention of change (ensure that the change becomes truly intentional); cultivate optimism (to help chronic pain patients to consider the present situation as being less desperate than it seems); ask open-ended questions (the direct questioning can be used to specify a request or reveal ambivalence about change); present personal feedback (the therapist provides the patient with a maximum of information that may help to appreciate the true value of the effectiveness of their current management of pain); review consequences of change versus non-change (to review the plausible positive (pros) and negative (cons) consequences of change); and summarizing (to summarize the key points discussed during the interview). In the active stage, therapists may use other strategies like: developing a plan for change (to suggest the adoption of certain coping strategies with pain); providing information advice (provide information advice in order to help chronic pain patients to determine how they will take concrete steps to initiate change); and using a change plan worksheet (help chronic pain patients to develop a synthetic view of the change process they will undertake).

The various strategies discussed in this article are intended to accompany chronic pain patients to a process of change to help them consider a fundamental change in their ways of managing pain, when they are insufficient, ineffective and/or unintentionally aggravating their situation. It is important to help chronic pain patients to become aware of the nature of the adaptive problems they face, but also opportunities for change that are offered in order to encourage them to manage more efficiently and more autonomously their physical and mental suffering. In this context of openness to change, motivational interviewing can be an invaluable help to build a good therapeutic alliance in order to maximize the impact of supported global and multidimensional chronic pain by including a cognitive-behavioral approach for example.