Table 1 Summary of the self-management group intervention

Session 1: Introduction; Basic principles of pain

Review purpose of the program/study. Review definition, types, & mechanisms of pain. Discuss myths about pain in older adults. Emphasize goals of chronic pain management. Discuss signs/symptoms that require medical attention. Introduce problem-solving techniques for pain management.

Session 2: Role of exercise & physical activity in pain management

Discuss exercise in pain management: problem of de-conditioning, types of exercise, tips for starting exercise program. Demonstrate & practice specific exercises. Introduce relaxation and breathing techniques as effective pain management strategies. Practice progressive muscle relaxation & abdominal breathing.

Session 3: Engaging in pleasant, meaningful activities; pacing activities

Discuss ways in which chronic pain may be limiting participation in enjoyable or meaningful activities Use problem solving to develop individualized plans for increasing these activities. Discuss strategies for activity pacing and rationale for avoiding guarding and inactivity. Practice relaxation.

Session 4: Challenging negative thoughts; Dealing with pain flare-ups and setbacks

Discuss critical role of thoughts and appraisals about pain in determining affective and behavioral responses to pain. Help participants to identify negative thoughts that they may have in response to pain. Practice challenging negative thoughts with positive thoughts about effective ways to manage pain. Discuss strategies for dealing with setbacks and pain-flare-ups. Practice relaxation.

Session 5: Non-drug pain therapies; Heat & cold; Dealing with pain flare-ups and setbacks (continued)

Describe rationale for using nondrug pain therapies. Describe and practice application of heat and cold; review precautions in using heat and cold for pain Continue discussion about coping with pain flare-ups & setbacks in pain management. Practice relaxation.

Session 6: Pain medications & complementary therapies

Describe the role of medications for pain management. Discuss the major types of pain medications. Describe the use of complementary therapies in pain management. Discuss steps in making informed decisions about all pain therapies.

Session 7: Pain management plan; Wrap-up

Discuss maintenance of gains made through the program. Review coping with set backs & pain flare-ups. Revise written individualized maintenance plans for each participant.