Self-management Of Chronic Pain Research Articles

Psychosocial interventions for chronic pain and comorbid prescription opioid use disorders: A narrative review of the literature.

Opioid misuse in the context of chronic noncancer pain (CNCP) is a multifaceted and complex issue. As opioid misuse and corresponding rates of addiction and overdose deaths exceed epidemic proportions, there is an urgent need for research in this area. The objective of this review is to evaluate the literature addressing psychosocial interventions targeting CNCP and prescription opioid misuse. A systematic search of PubMed, MEDLINE, PsychINFO, ClinicalTrials.gov was conducted to identify studies evaluating psychosocial interventions targeting CNCP and prescription opioid misuse. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 56 peer-reviewed research articles from 1993 to July, 2016, which included studies of psychosocial interventions for CNCP and opioid use disorders. Studies that examined psychosocial interventions for CNCP, treatment modalities included: cognitive behavioral therapy (CBT), acceptance and commitment therapy, mindfulness-based cognitive therapy and mindfulness-based stress reduction, and chronic pain self-management programs. The psychosocial interventions for opioid misuse included: CBT and relapse prevention, motivational enhancement therapy and stages of change, contingency management, and self-help and peer support-based groups. The findings of this review offer clinical insight and reinforce the importance of psychosocial interventions in CNCP and opioid use disorders. However, little empirical data are available to guide practitioners in treating patients with CNCP who misuse opioid medications, and thus future research on integrated approaches, is needed.

PSY38 - Development and Validity Assessment of an Exposure Score Tool For Chronic Pain Self-Management Strategies

PSY38 - Development and Validity Assessment of an Exposure Score Tool For Chronic Pain Self-Management Strategies

Randomized Trial of a Low-Literacy Chronic Pain Self-Management Program: Analysis of Secondary Pain and Psychological Outcome Measures

Based on input of rural, largely Hispanic persons with chronic pain, a low-literacy, 6-month self-management program was developed, drawing on elements of existing pain toolkits. In a randomized trial, low-income, primarily Hispanic patients with chronic pain received the program in 6 sessions of 1-on-1 meetings with a trained health educator in clinic or in 8 group lectures by experts in the community. Intention-to-treat analyses in linear mixed-effects models were conducted for 5 secondary outcomes at 6 months, including Brief Pain Inventory pain severity and interference, Patient Health Questionnaire-9, 12-Item Short-Form Survey Mental Component Summary, and Tampa Scale for Kinesiophobia-11. A total of 111 participants were randomized (15.9% of 700 initially eligible from 3 clinics), and 67 (60.4%) completed 6-month measures. Among completers, the clinic arm improved on 4 measures and community arm on 3 measures (all P < .05). Effect sizes were small to moderate (.41–.52). In intention-to-treat analyses, both arms improved on 4 of 5 measures (all P ≤ .001) versus baseline, with clinically significant changes in Brief Pain Inventory pain severity and interference. Improvement in multiple outcomes after this chronic pain self-management program for low-income patients warrants further study. PerspectiveIn an evaluation of a low-literacy, 6-month chronic pain self-management program, similar improvements were observed among primarily Hispanic participants whether the intervention was delivered by a health educator or in groups with lectures from experts.

Physical and Psychosocial Factors in the Prevention of Chronic Pain in Older Age

Chronic pain is recognized as a major challenge as people age. Yet, despite growing research on chronic pain management, there is little research into chronic pain prevention. Thus there is a clear need to identify multimodal activities that could be encouraged among older adults as part of a healthy lifestyle to decrease the incidence risk of chronic pain. Using data from the English Longitudinal Study of Ageing we tracked 2,631 adults aged ≥50 years who were free from chronic pain at baseline across a decade and explore whether physical or psychosocial factors reduced the risk of developing chronic pain. In relation to physical factors, engaging in vigorous weekly activity was protective against the development of chronic pain (odds ratio 0.74, standard error 0.07, 95% confidence interval 0.62–0.89) when controlling for all identified socioeconomic, health, and social confounders. However, no effects were found for moderate weekly activity. In relation to psychosocial factors, cultural engagement was also protective against the development of chronic pain (odds ratio 0.75, standard error 0.07, 95% confidence interval 0.63–0.91), but community group participation was not. These findings extend previous work showing that physical activity and psychosocial factors such as positive affect are key factors in the long-term success of chronic pain self-management. Future interventional studies for chronic pain are encouraged. PerspectiveThis article explores whether physical and psychosocial activities could reduce the risk of developing chronic pain in older age. These results could potentially help clinicians to recommend multimodal activities as part of a broader healthy lifestyle for those aged ≥50 years to reduce the incidence rate of chronic pain.

The Management of Chronic Back Pain in Primary Care Settings: Exploring Perceived Facilitators and Barriers to the Development of Patient-Professional Partnerships.

Supporting patients in forming partnerships with health professionals is the key of effective self-management. This study aimed to explore the nature of patient-professional partnerships and its related factors that create facilitators and barriers to patients' self-management ability. A constructivist grounded theory approach was undertaken. Three main themes emerged: interaction and communication, integrated care, and service and system. A theoretical model was generated that posits effective communication, individualized integrated care, and high-quality service as key influences on the successful development of patient-professional partnerships and patients' ability to self-manage. Giving attention to these factors helps understand the development, implementation, mechanisms, and evaluation of building a patient-professional partnership and maximizes the opportunities for patient self-management of chronic pain. Future research and practice are needed to move beyond a simplistic focus on health outcomes to address the complex links between partnerships and treatment delivery processes, and interventions, effects, and patients' context.

The association between patient-professional partnerships and self-management of chronic back pain: A mixed methods study.

Self-management is recommended for patients with chronic back pain. Health professionals' support for self-management can be more effective when working in partnership with patients. The aim of this study was to investigate the associations between patient-professional partnerships and the self-management of chronic back pain. An explanatory sequential mixed methods study was undertaken. Adults with chronic back pain referred to pain management clinics participated at baseline and 3-month follow-up. Their pain severity, partnerships with health professionals and self-management ability were measured. Hierarchical linear regression was undertaken to examine the strength of the associations between partnerships and self-management. A subsample was interviewed about experiences of the impact of patient-professional partnerships on their self-management ability, using a grounded theory approach. A total of 147 patients were recruited and 103 (70%) patients completed the follow-up. A strong association (p<0.001) was detected between patient-professional partnerships and all dimensions of self-management ability. This was validated by interviews with a subsample of 26 patients. Four themes emerged as follows: connecting with health professionals, being supported through partnerships, feeling positive and making progress towards self-management, and acknowledging the impact but feeling no difference. Developing a partnership in care may improve patients' ability to gain knowledge, manage side effects and symptoms and adhere to treatment. It helped strengthen health professionals' support and produce a sense of safety for patients. Guiding health professionals in building partnerships where expectations are acknowledged and tailored information and support are provided could be considered as part of the standard education and training. This study identified and validated strong associations between patient-professional partnerships and self-management. Support for self-management alone may not be sufficient, and building partnerships where patients and professionals work together towards agreed goals make an essential contribution to helping increase patients' ability to self-manage chronic back pain.

A Controlled Pilot Trial of PainTracker Self-Manager, a Web-Based Platform Combined With Patient Coaching, to Support Patients' Self-Management of Chronic Pain

The objective of this study was to develop and pilot test a chronic pain empowerment and self-management platform, derived from acceptance and commitment therapy, in a pain specialty setting. A controlled, sequential, nonrandomized study design was used to accommodate intervention development and to test the efficacy of the PainTracker Self-Manager (PTSM) intervention (Web-based educational modules and outcome tracking combined with tailored patient coaching sessions and provider guidance). Generalized estimating equations evaluated changes over time (baseline, 3 months, 6 months) in pain self-efficacy (primary outcome), chronic pain acceptance (activity engagement and pain willingness), perceived efficacy in patient–provider interactions, pain intensity and interference, and overall satisfaction with pain treatment (secondary outcomes) between intervention (n = 48) and usual care control groups (n = 51). The full study sample (N = 99) showed greater improvements over time (significant Group × Time interactions) in pain self-efficacy and satisfaction with pain treatment. Among study completers (n = 82), greater improvement in activity engagement as well as pain intensity and interference were also observed. These preliminary findings support the efficacy of the PTSM intervention in a pain specialty setting. Further research is needed to refine and expand the PTSM intervention and to test it in a randomized trial in primary care settings. PerspectiveWe developed a Web-based patient empowerment platform that combined acceptance and commitment therapy-based educational modules and tailored coaching sessions with longitudinal tracking of treatments and patient-reported outcomes, named PTSM. Pilot controlled trial results provide preliminary support for its efficacy in improving pain self-efficacy, activity engagement, pain intensity and interference, and satisfaction with pain treatment.

Capsule Commentary on Turner et al., Randomized Trial of Chronic Pain Self-management Program in Community or Clinic for Low-Income Primary Care Patients.

Capsule Commentary on Turner et al., Randomized Trial of Chronic Pain Self-management Program in Community or Clinic for Low-Income Primary Care Patients.

Moving Forward with Physical Activity: Self-Management of Chronic Pain among Women

Moving Forward with Physical Activity: Self-Management of Chronic Pain among Women

Randomized Trial of Chronic Pain Self-Management Program in the Community or Clinic for Low-Income Primary Care Patients

BackgroundPatients with chronic pain often lack the skills and resources necessary to manage this disease.ObjectiveTo develop a chronic pain self-management program reflecting community stakeholders’ priorities and to compare functional outcomes from training in two settings.DesignA parallel-group randomized trial.ParticipantsEligible subjects were 35–70 years of age, with chronic non-cancer pain treated with opioids for >2 months at two primary care and one HIV clinic serving low-income Hispanics.InterventionsIn one study arm, the 6-month program was delivered in monthly one-on-one clinic meetings by a community health worker (CHW) trained as a chronic pain health educator, and in the second arm, content experts gave eight group lectures in a nearby library.Main MeasuresFive times Sit-to-Stand test (5XSTS) assessed at baseline and 3 and 6 months. Other reported physical and cognitive measures include the 6-Min Walk (6 MW), Borg Perceived Effort Test (Borg Effort), 50-ft Speed Walk (50FtSW), SF-12 Physical Component Summary (SF-12 PCS), Patient-Specific Functional Scale (PSFS), and Symbol–Digit Modalities Test (SDMT). Intention-to-treat (ITT) analyses in mixed-effects models adjust for demographics, body mass index, maximum pain, study arm, and measurement time. Multiple imputation was used for sensitivity analyses.Key ResultsAmong 111 subjects, 53 were in the clinic arm and 58 in the community arm. In ITT analyses at 6 months, subjects in both arms performed the 5XSTS test faster (−4.9 s, P = 0.001) and improved scores on Borg Effort (−1, P = 0.02), PSFS (1.6, P < 0.001), and SDMT (5.9, P < 0.001). Only the clinic arm increased the 6 MW (172.4 ft, P = 0.02) and SF-12 PCS (6.2 points, P < 0.001). 50ftSW did not change (P = 0.15). Results were similar with multiple imputation. Five falls were possible adverse events.ConclusionsIn low-income subjects with chronic pain, physical and cognitive function improved significantly after self-management training from expert lectures in the community and in-clinic meetings with a trained health educator.

Precision Health: Use of Omics to Optimize Self-Management of Chronic Pain in Aging.

Chronic pain has become a public health epidemic based on the number of Americans affected and its associated health care costs. Unfortunately, there are few efficacious treatments to manage chronic pain and as the population of older adults and centenarians who are at high risk for chronic pain continues to grow, the chronic pain epidemic will continue to worsen unless new therapeutic strategies are discovered. In the current era of precision medicine, there is a major emphasis being placed on the use of self-management and omics to discover new therapeutic targets and design treatment strategies that are tailored to the individual patient. This commentary discusses the current state of the science related to omics and self-management of chronic pain in older adults, the role of gerontological nurses in this process, and future directions. [Res Gerontol Nurs. 2018; 11(1):7-13.].

The Role of Emotion Regulation in Chronic Pain Self-Management

The Role of Emotion Regulation in Chronic Pain Self-Management

Response to the Commentary: Precision Health: Using Omics to Optimize Self-Management of Chronic Pain in Aging: From the Perspective of the NINR Intramural Research Program.

Response to the Commentary: Precision Health: Using Omics to Optimize Self-Management of Chronic Pain in Aging: From the Perspective of the NINR Intramural Research Program.

Participants and developers experiences with a chronic pain self-management intervention under development: A qualitative study.

Background:Non-pharmacological interventions aim to promote health and self-management for people with chronic pain.Objective:The aim of this study was to explore if the participants’ experiences with a self-management intervention under development were aligned with the developers’ rationale and desired outcome of the intervention.Methods:This was a qualitative study interviewing both participants and developers of a chronic pain self-management intervention. Seven participants, six females and one male in the age from early thirties to mid-seventies attended the chronic pain self-management intervention developed by the staff at a Healthy Life Centre. The data were analysed by the systematic text condensation method.Results:The analyses showed that the participants evaluated the intervention as valuable. They described using coping techniques to manage their chronic pain better, and the developers stated that the aim with the intervention was to provide the participants with coping techniques. The intervention was built upon the developers’ professional knowledge and experience in cognitive techniques, health theories, models for behavioural change, and service user involvement.Conclusion:This study found that the chronic pain self-management intervention was in concordance with theory of health promotion and empowerment. The participants experienced the intervention as targeting their resources, capacities, and fulfilling social needs, which aligned with the developers aim with the intervention. The participants found the intervention evocative; they learned new ways to manage their pain through theory/education, movement exercises, homework, and sharing their experiences with each other.

048. Efficacy of a Pain Education Workshop in Enhancing Patient and Parental Confidence in Knowledge and Self-Management of Paediatric Chronic Pain

048. Efficacy of a Pain Education Workshop in Enhancing Patient and Parental Confidence in Knowledge and Self-Management of Paediatric Chronic Pain

Evaluation of uptake and effect on patient-reported outcomes of a clinician and patient co-led chronic musculoskeletal pain self-management programme provided by the UK National Health Service.

In the United Kingdom, chronic pain affects approximately 28 million adults, creating significant healthcare and socio-economic costs. The aim was to establish whether a programme designed to use best evidence of content and delivery will be used by patients with significant musculoskeletal pain problems. Of 528 patients recruited, 376 participated in a 7-week-long group-based self-management programme (SMP) co-delivered by clinical and lay tutors. Of these, 308 patients (mean age, 53 years; 69% females, 94% White) completed at least five SMP sessions. Six months after pre-course assessment, participants reported significantly improved patient activation and health status, lower depression and anxiety scores, decreased pain severity and interference, and improved self-management skills. There were no improvements in health state and pain self-efficacy. Uptake rate was 71% and completion 82%. The results should be of value to commissioners of pathways of care for the large numbers of patients attending the English NHS for chronic musculoskeletal pain.

What Are the Barriers and Facilitators for the Self-Management of Chronic Pain with and without Neuropathic Characteristics?

Chronic pain requires affected individuals to self-manage their health. This study compared barriers and facilitators of self-management in two groups of people with chronic pain: those with and without neuropathic characteristics. A cross-sectional survey study of community-dwelling Canadians was conducted. The sample (n = 710) included randomly selected participants who reported chronic pain. The Self-Report Leeds Assessment of Neuropathic Symptoms and Signs was used to screen for neuropathic characteristics. Barriers and facilitators of self-management included self-efficacy (Pain Self-Efficacy Questionnaire), depression (Patient Health Questionnaire 9), social support and relationship with health care provider (Chronic Illness Resources Survey), and pain intensity (numeric rating scale). Participants were asked which factors they felt made pain management easier or harder. Statistical analyses included frequency, percent, relative risk (RR), and 95% confidence intervals (CI). Self-confidence to manage pain was the most commonly perceived self-management barrier/facilitator by both groups; however, participants with neuropathic characteristics (n = 188) were more likely to report low self-efficacy than those without neuropathic characteristics (n = 522) (RR = 2.1, CI = 1.62-2.72, ref = high self-efficacy). Participants with neuropathic characteristics were also more likely to screen positive for depression (RR = 2.30, CI = 1.73-3.06, ref = no/mild depression). There were no group differences in social support and relationship with health professional, but 40.8% felt they were not involved as equal partners in decision making and goal setting related to their care. Health professionals should consider collaborative decision making when seeking to support self-management abilities. Addressing low self-efficacy and depression may be especially important for supporting self-management by individuals with neuropathic characteristics.

Supporting the Self-Management of Chronic Pain Conditions with Tailored Momentary Self-Assessments.

To better support the self-management of chronic pain, this paper investigates how those living with the condition prefer to self-assess their pain levels using smartphones. Our work consists of three stages: design ideation and review, an in-lab user study with 10 participants resulting in nine candidate interfaces, and a 3 week field trial of two further honed measures with 12 participants. This research firstly yields a better understanding of participants' strong and sometimes contrasting preferences regarding their self-assessment of pain intensity. We additionally contribute two novel interfaces that support accurate, quick, and repeated use along with other participant-valued interactions (e.g., familiar, relatable, and highly usable). In particular, we focus on designing tailored measures that both enhance respondent motivation as well as minimize the difficulty of meaningful self-assessment by supporting the cog-nitive effort in translating a subjective experience into a single numerical value.

The effect of a lay-led, group-based self-management program for patients with chronic pain: a randomized controlled trial of the Danish version of the Chronic Pain Self-Management Programme.

The Stanford Chronic Pain Self-Management Programme (CPSMP) consists of 6 2½-hour weekly workshops focusing on how to manage pain in daily life. The workshops are facilitated by 2 workshop leaders of whom at least 1 must suffer from a long-term pain condition. The program is highly structured and manualized. Only few controlled trials testing the effect of CPSMP exist. Enrolled in the study were 424 adults from 19 Danish municipalities, (72% women; age: 25-93 years) with pain of any etiology and great variation in pain history (0-50 yrs). Of these, 216 were randomized to a lay-led version of the CPSMP. The primary outcome was pain-related disability. Secondary outcomes were pain, pain catastrophizing, self-efficacy, emotional distress, physical symptoms, and illness worry. Outcomes were measured before randomization, immediately after the CPSMP (response rate: 94%), and at 3-month follow-up (response rate: 92%). National register data on health expenditure were obtained to examine effects on health care use. ClinicalTrials.gov Identifier: NCT01306747. The CPSMP had no effect on the primary outcome pain-related disability or on health expenditure during intervention and follow-up period. Small positive effects on emotional distress and illness worry 3 months after CPSMP were observed. Lay-led CPSMP is not recommended as treatment for chronic pain-related disability. This heterogeneous group of patients with pain did not benefit from the CPSMP except for a small, but clinically insignificant improvement in psychological well-being.

Interactive Voice Response–Based Self-management for Chronic Back Pain

Recommendations for chronic pain treatment emphasize multimodal approaches, including nonpharmacologic interventions to enhance self-management. Cognitive behavioral therapy (CBT) is an evidence-based treatment that facilitates management of chronic pain and improves outcomes, but access barriers persist. Cognitive behavioral therapy delivery assisted by health technology can obviate the need for in-person visits, but the effectiveness of this alternative to standard therapy is unknown. The Cooperative Pain Education and Self-management (COPES) trial was a randomized, noninferiority trial comparing IVR-CBT to in-person CBT for patients with chronic back pain. To assess the efficacy of interactive voice response-based CBT (IVR-CBT) relative to in-person CBT for chronic back pain. We conducted a noninferiority randomized trial in 1 Department of Veterans Affairs (VA) health care system. A total of 125 patients with chronic back pain were equally allocated to IVR-CBT (n = 62) or in-person CBT (n = 63). Patients treated with IVR-CBT received a self-help manual and weekly prerecorded therapist feedback based on their IVR-reported activity, coping skill practice, and pain outcomes. In-person CBT included weekly, individual CBT sessions with a therapist. Participants in both conditions received IVR monitoring of pain, sleep, activity levels, and pain coping skill practice during treatment. The primary outcome was change from baseline to 3 months in unblinded patient report of average pain intensity measured by the Numeric Rating Scale (NRS). Secondary outcomes included changes in pain-related interference, physical and emotional functioning, sleep quality, and quality of life at 3, 6, and 9 months. We also examined treatment retention. Of the 125 patients (97 men, 28 women; mean [SD] age, 57.9 [11.6] years), the adjusted average reduction in NRS with IVR-CBT (-0.77) was similar to in-person CBT (-0.84), with the 95% CI for the difference between groups (-0.67 to 0.80) falling below the prespecified noninferiority margin of 1 indicating IVR-CBT is noninferior. Fifty-four patients randomized to IVR-CBT and 50 randomized to in-person CBT were included in the analysis of the primary outcome. Statistically significant improvements in physical functioning, sleep quality, and physical quality of life at 3 months relative to baseline occurred in both treatments, with no advantage for either treatment. Treatment dropout was lower in IVR-CBT with patients completing on average 2.3 (95% CI, 1.0-3.6) more sessions. IVR-CBT is a low-burden alternative that can increase access to CBT for chronic pain and shows promise as a nonpharmacologic treatment option for chronic pain, with outcomes that are not inferior to in-person CBT. clinicaltrials.gov Identifier: NCT01025752.