Table 2.

Expert vs ‘true’ self-management approaches to pain self-management

Expert driven	True self-management
Give a set of home exercises.	Teach patient to manage and progress own exercise programme.
Give patient goals and homework.	Support patient to develop flexible and independent goal-setting skills.
Solve problems for patient.	Where appropriate, refrain from expert problem solving and create an opportunity for patient to use own skills.
Presume that correct information and education will suffice for behaviour change.	Give good explanations and information, yet acknowledge that difficult habit change will require difficult repeated practice.
React to crisis/pain flare by taking charge, reassuring, and projecting authority.	Stay close to key message that ‘hurt does not equal harm’, project the idea that the patient does not necessarily need ‘rescuing’, and that the patient has behavioural choices and options in the face of pain and difficulty.