Online Self-Management for Chronic Burn Pain: Results of a Randomized Controlled Trial

Abstract

Following burn injury, survivors experience high rates of chronic pain and psychosocial concerns, including post-traumatic stress disorder (PTSD) and depression. Despite long-term pain and distress, survivors have limited access to effective pain psychology treatments after discharge in the United States. The current study compared the efficacy of an online self-management program for chronic pain after burn injuries to a time equivalent education control. The Take Charge of Burn Pain Recovery (TCBR-Pain) program involved seven online chronic pain coping modules based on cognitive-behavioral therapy. Adults at least six months post burn injury hospital discharge and experiencing pain greater than 3/10 severity were recruited and randomized into the TCBR-Pain (N = 47) or Control program (N = 49). Outcomes were assessed at pre-treatment, immediately post-treatment, 2-month, and 5-month follow-up. Full program completion was lower for the TCBR-Pain group (53%) relative to the Control group (90%). Linear models were fit to outcomes, adjusting for pre-treatment scores, adherence, and completion. On average, the TCBR-Pain group reported lower pain intensity relative to the Control group at post-treatment (MTCBR-Pain = 3.2, SDTCBR-Pain = 1.8; MControl = 4.1, SDControl = 1.9; p < .001). Among secondary outcomes, the TCBR-Pain group reported lower pain catastrophizing (MTCBR-Pain = 14.0, SDTCBR-Pain = 10.3; MControl = 17.6, SDControl = 11.8; p = .03) and borderline effects toward lower PTSD symptoms (MTCBR-Pain = 14.0, SDTCBR-Pain = 6.5; MControl = 16.0, SDControl = 6.1; p = .08) at post-treatment relative to the Control group. Although preliminary, these findings suggest online self-management programs can serve a role in delivering effective pain psychology interventions to survivors with chronic burn pain. The TCBR-Pain program attrition rate was higher than the Control program, but lower than typical e-health intervention attrition rates (60–80%). However, future research is needed to improve patient engagement in online pain self-management programs.