1
|
Dear BF, Gilmore S, Campbell N, Titov N, Beeden A. Internet-Delivered Psychological Pain Management: A Prospective Cohort Study Examining Routine Care Delivery by a Specialist Regional Multidisciplinary Pain Service. THE JOURNAL OF PAIN 2024:104601. [PMID: 38871146 DOI: 10.1016/j.jpain.2024.104601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
Several clinical trials have demonstrated the effectiveness of internet-delivered psychological-based pain management programs (PMPs). However, to date, no large studies have reported the outcomes of PMPs when delivered by specialist multidisciplinary pain services in routine care. The present study reports (n = 653) the outcomes of an internet-delivered PMP provided as routine care by a specialist Australian regional pain service over a 6-year period. High levels of treatment commencement (85%) and completion (72%) were observed, with more than 80% of patients reporting they were satisfied with the intervention. Clinical improvements were observed from pretreatment to post-treatment (% change, 95% confidence intervals (CI)) in pain-related disability (8.8%; 4.5, 12.8), depression (28.4%; 23.0, 33.4), anxiety (21.9%; 14.6, 28.5), and pain intensity (7%; 3.5, 10.5), which were maintained to 3-month follow-up. At 3-month follow-up, 27% (23, 31), 46% (41, 51), 44% (39, 49), and 22% (19, 26) reported clinically meaningful (defined as ≥ 30%) improvements in pain-related disability, depression, anxiety, and pain intensity, respectively. These results were obtained with relatively little therapist time per patient (M = 30.0, (standard deviation) SD = 18.8) to deliver the intervention. The current findings highlight the potential of internet-delivered PMPs as part of the services provided by specialist pain services, particularly those servicing large geographical regions and for patients unable to travel to clinics for face-to-face care. PERSPECTIVE: This study reports the outcomes of the routine delivery of an internet-delivered psychological PMP by a specialist pain service. The findings highlight the potential of this model of care when provided by specialist pain services, particularly for patients not unable to attend and not requiring intensive face-to-face care.
Collapse
Affiliation(s)
- Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia.
| | - Shereen Gilmore
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Nicole Campbell
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Alison Beeden
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| |
Collapse
|
2
|
Dudeney J, Scott AJ, Hathway T, Bisby MA, Harte N, Titov N, Dear BF. Internet-Delivered Psychological Pain-Management for Young Adults With Chronic Pain: An Investigation of Clinical Trial Data. THE JOURNAL OF PAIN 2024; 25:104447. [PMID: 38122876 DOI: 10.1016/j.jpain.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
Young adults report chronic pain at rates of around 12% but lack access to clinical services. There is interest in learning how this emerging adult population engages with and responds to treatment. Using data from young adults aged 18 to 30 years (Mage = 25.8, SD = 3.2), taken from 4 previous randomised controlled trials, the current study investigated the feasibility, acceptability, and efficacy of an internet-delivered psychological pain-management intervention for young adults with chronic pain. We compared young adults in a treatment group (n = 104) with 1) a young-adult wait-list control group (n = 48), and 2) a treatment group reflecting the average-aged participant from the previous trials (39-63 years, n = 561). Feasibility was determined through treatment engagement, adherence and completion, and acceptability through a treatment satisfaction measure. Clinical outcomes were disability, pain intensity, anxiety, and depression; assessed at pre-treatment, post-treatment, and 3-month follow-up. Generalised estimation equation analyses were undertaken, using multiple imputations to account for missing data. Young adults had high engagement and acceptability ratings, though 34% did not complete the intervention. The treatment group significant improved across all outcomes, compared with control, with improvements maintained at follow-up. Post-treatment improvements were equivalent for young-adult and average-aged adult treatment groups, with no significant differences in feasibility or acceptability outcomes. Findings indicate young adults can engage with and show improvements following a psychological pain-management intervention designed for all adults with chronic pain. Future research is encouraged to examine outcomes related to role functioning of young adults, and moderators of treatment acceptability and efficacy for this population. PERSPECTIVE: Secondary analysis of data from 4 RCTs found an Internet-delivered psychological pain-management intervention acceptable and clinically efficacious for improving disability, anxiety, depression and pain intensity in young adults (18-30) with chronic pain.
Collapse
Affiliation(s)
- Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Amelia J Scott
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Taylor Hathway
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney NSW, Australia
| | - Nicole Harte
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney NSW, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney NSW, Australia
| |
Collapse
|
3
|
Antunes TPC, Jardim FG, de Oliveira Abreu CIP, de Abreu LC, Bezerra IMP. Chronic Pain Self-Management Strategies for Older Adults: An Integrative Review. Life (Basel) 2024; 14:707. [PMID: 38929690 PMCID: PMC11204825 DOI: 10.3390/life14060707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Due to the complex nature of chronic pain, especially in older adults, a biopsychosocial approach is more effective than an isolated approach for its management. Furthermore, when patients are actively engaged in their pain management, they are more likely to be successful than relying totally on others. OBJECTIVE To analyze the self-management strategies currently used by older adults with chronic pain. METHOD An integrative review was conducted through seven online databases, searching for scientific studies on this topic published in the last 10 years. RESULTS AND CONCLUSION Fifty-eight studies were included in the final sample. Research on chronic pain self-management for older adults has increased in recent years. Although a diversity of chronic physical painful conditions are being investigated, many conditions are still under-investigated. Online and in-person strategies are currently adopted, demonstrating similar results. Positive results are evidenced by strategies including health promotion, mind control, social participation and take-action fields. Major results come from a combination of strategies focusing on biopsychosocial aspects of pain management. Results include not only the reduction of pain itself, but increased self-efficacy, adoption of health behaviors and improvement of functionality, among others, i.e., improved QoL, despite pain.
Collapse
Affiliation(s)
- Thaiany Pedrozo Campos Antunes
- Public Policy and Local Development Department, Superior School of Sciences of the Santa Casa de Misericórdia de Vitória, Vitória 29045-402, Espirito Santo, Brazil; (T.P.C.A.); (F.G.J.); (L.C.d.A.)
| | - Fernanda Golçalves Jardim
- Public Policy and Local Development Department, Superior School of Sciences of the Santa Casa de Misericórdia de Vitória, Vitória 29045-402, Espirito Santo, Brazil; (T.P.C.A.); (F.G.J.); (L.C.d.A.)
| | | | - Luiz Carlos de Abreu
- Public Policy and Local Development Department, Superior School of Sciences of the Santa Casa de Misericórdia de Vitória, Vitória 29045-402, Espirito Santo, Brazil; (T.P.C.A.); (F.G.J.); (L.C.d.A.)
- Department of Preventive Medicine, Federal University of Espirito Santo, Vitória 29075-910, Espírito Santo, Brazil;
| | - Italla Maria Pinheiro Bezerra
- Public Policy and Local Development Department, Superior School of Sciences of the Santa Casa de Misericórdia de Vitória, Vitória 29045-402, Espirito Santo, Brazil; (T.P.C.A.); (F.G.J.); (L.C.d.A.)
| |
Collapse
|
4
|
Chew MT, Ilhan E, Nicholson LL, Kobayashi S, Chan C. An online pain management program for people with hypermobile Ehlers-Danlos Syndrome or hypermobility spectrum disorder: a three-staged development process. Disabil Rehabil 2024:1-11. [PMID: 38738812 DOI: 10.1080/09638288.2024.2351180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorder (HSD) are painful, chronic and multi-systemic conditions. No online pain management programs for hEDS/HSD currently exist. We aimed to develop one by exploring what people with hEDS/HSD want in such programs. MATERIALS AND METHODS A Delphi was conducted via online surveys of stakeholders: participants with hEDS/HSD and healthcare professionals (HCP). In survey 1, participants were asked if a hEDS/HSD-specific online pain management program was important, listing up to 20 topics important to know about pain. In survey 2, participants rated the importance of those topics. Consensus was set as ≥75% rating of at least "important". Using topics that reached consensus, the online program was developed. Usability testing was performed using the Systems Usability Scale (SUS). RESULTS 396 hEDS/HSD and 29 HCP completed survey 1; 151 hEDS/HSD and 12 HCP completed survey 2. 81% of hEDS/HSD and 69% of HCP rated a hEDS/HSD-specific program as at least "important". Thirty-five topics reached consensus to guide content for the HOPE program (Hypermobile Online Pain managemEnt). SUS score was 82.5, corresponding to "high acceptability". CONCLUSIONS A hEDS/HSD-specific online pain management program is important to stakeholders. Utilising a Delphi approach to incorporate stakeholder input, an evidence-informed and user appropriate program was developed.
Collapse
Affiliation(s)
- Min Tze Chew
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Emre Ilhan
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Leslie L Nicholson
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sarah Kobayashi
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Cliffton Chan
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
5
|
Bisby MA, Correa AB, Trujillo R, Dudeney J, Dear BF. Sudden gains in depression and anxiety during an online pain management programme for chronic pain. Eur J Pain 2024. [PMID: 38736167 DOI: 10.1002/ejp.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Chronic pain is associated with depression and anxiety symptoms. Pain management programms, delivered face-to-face or via the internet, can effectively help adults manage the impacts of chronic pain. Sudden gains are defined as substantial, rapid, and lasting symptom reductions that occur between consecutive treatment sessions and have been associated with better treatment outcomes in non-pain samples. This study examined whether adults with chronic pain report sudden gains in depression or anxiety symptoms during an 8-week online pain management programme, and whether sudden gains were associated with better treatment outcomes for depression or anxiety. Dominant theories of sudden gains argue that therapists are required for sudden gains to be maintained and improve treatment outcomes. METHODS Using data from a published randomized controlled trial (n = 338), sudden gains and treatment outcomes were compared across three levels of therapist guidance provided alongside the programme: weekly, optional, and self-guided. RESULTS Similar rates of sudden gains were observed in depression (22%) and anxiety (24%) across the treatment period, and most sudden gains occurred between Weeks 1 and 2 of treatment. Therapist guidance was not associated with sudden gains; higher baseline symptom severity emerged as the only consistent predictor of sudden gain status. No significant differences in treatment outcomes for depression or anxiety symptoms between sudden gainers and non-gainers were observed across therapist guidance conditions. CONCLUSIONS These results do not support an association between sudden gains in depression or anxiety symptoms and better post-treatment outcomes, at least for adults with chronic pain. SIGNIFICANCE STATEMENT Sudden gains in depression and anxiety symptoms were not associated with improved treatment outcomes for adults with chronic pain who participated in an online pain management programme, regardless of the level of therapist guidance provided. These findings suggest possible differences in symptom change in chronic pain samples compared to general population samples.
Collapse
Affiliation(s)
- Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Ashleigh B Correa
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Rachel Trujillo
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| |
Collapse
|
6
|
Terpstra JA, van der Vaart R, van Beugen S, van Eersel RA, Gkika I, Erdős D, Schmidt J, Radstake C, Kloppenburg M, van Middendorp H, Evers AW. Guided internet-based cognitive-behavioral therapy for patients with chronic pain: A meta-analytic review. Internet Interv 2022; 30:100587. [PMID: 36406977 PMCID: PMC9672957 DOI: 10.1016/j.invent.2022.100587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Chronic pain has a large individual and societal burden. Previous reviews have shown that internet-based cognitive-behavioral therapy (iCBT) can support patients' pain coping. However, factors related to participant experience of iCBT and effective and safe iCBT delivery for chronic pain have not recently been summarized. OBJECTIVE The aim of this review was to give an overview of the efficacy of guided iCBT for chronic pain on psychological, physical, and impact on daily life outcomes, including factors that inform optimal delivery. METHODS Cochrane, Emcare, Web of Science, PubMed, PsycINFO, and Embase were systematically searched from inception to 11 February 2022. Randomized controlled trials on guided iCBTs for adults with chronic pain were included with a broad range of outcomes. RESULTS The search yielded 7406 studies of which 33 studies were included totaling 5133 participants. ICBT was more effective than passive control conditions for psychological (ES = 0.34-0.47), physical (ES = 0.26-0.29), and impact outcomes (ES = 0.38-0.41). ICBT was more effective than active control conditions for distress (ES = 0.40), pain acceptance (ES = 0.15), and pain interference after outlier removal (ES = 0.30). Longer treatments were associated with larger effects for anxiety and quality of life than shorter treatments. Mode of therapist contact (synchronous, asynchronous or a mix of both) was not related to differences in effect sizes in most outcomes. However, studies with mixed and synchronous contact modes had higher effects on pain self-efficacy than studies with asynchronous contact modes. Treatment satisfaction was high and adverse events were minor. Dropout was related to time, health, technical issues, and lack of computer skills. CONCLUSIONS Guided iCBT is an effective and potentially safe treatment for chronic pain. Future research should more consistently report on iCBT safety and detail the effectiveness of individual treatment components to optimize iCBT in clinical practice.
Collapse
Affiliation(s)
- Jessy A. Terpstra
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands,Corresponding author at: Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB, Leiden, the Netherlands.
| | - Rosalie van der Vaart
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Sylvia van Beugen
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Roxy A. van Eersel
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Ioanna Gkika
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Dorottya Erdős
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Jana Schmidt
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Caroline Radstake
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Margreet Kloppenburg
- Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Andrea W.M. Evers
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Psychiatry, B1-P, PO Box 9600, 2300 RC Leiden, the Netherlands,Medical Delta, Huismansingel 4, 2629 JH Delft, the Netherlands
| |
Collapse
|
7
|
Turesson C, Liedberg G, Björk M. Development of a Digital Support Application With Evidence-Based Content for Sustainable Return to Work for Persons With Chronic Pain and Their Employers: User-Centered Agile Design Approach. JMIR Hum Factors 2022; 9:e33571. [PMID: 35285814 PMCID: PMC8961348 DOI: 10.2196/33571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Persons with chronic pain experience a lack of support after completing rehabilitation and the responsibility for the return-to-work (RTW) process is taken over by the employer. In addition, employers describe not knowing how to support their employees. Smartphone apps have been increasingly used for self-management, but there is a lack of available eHealth apps with evidence-based content providing digital support for persons with chronic pain and their employers when they return to work. OBJECTIVE This study aims to describe the development of a digital support application with evidence-based content that includes a biopsychosocial perspective on chronic pain for sustainable RTW for persons with chronic pain and their employers (SWEPPE [Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers]). METHODS A user-centered agile design approach was applied. The multidisciplinary project team consisted of health care researchers, a user representative, and a software team. A total of 2 reference groups of 7 persons with chronic pain and 4 employers participated in the development process and usability testing. Mixed methods were used for data collection. The design was revised using feedback from the reference groups. The content of SWEPPE was developed based on existing evidence and input from the reference groups. RESULTS The reference groups identified the following as important characteristics to include in SWEPPE: keeping users motivated, tracking health status and work situation, and following progress. SWEPPE was developed as a smartphone app for the persons with chronic pain and as a web application for their employers. SWEPPE consists of six modules: the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. The employers found the following functions in SWEPPE to be the most useful: employees' goals related to RTW, barriers to RTW, support wanted from the employer, and the ability to follow employees' progress. The persons with chronic pain found the following functions in SWEPPE to be the most useful: setting a goal related to RTW, identifying barriers and strategies, and self-monitoring. Usability testing revealed that SWEPPE was safe, useful (ie, provided relevant information), logical, and easy to use with an appealing interface. CONCLUSIONS This study reports the development of a digital support application for persons with chronic pain and their employers. SWEPPE fulfilled the need of support after an interdisciplinary pain rehabilitation program with useful functions such as setting a goal related to RTW, identification of barriers and strategies for RTW, self-monitoring, and sharing information between the employee and the employer. The user-centered agile design approach contributed to creating SWEPPE as a relevant and easy-to-use eHealth intervention. Further studies are needed to examine the effectiveness of SWEPPE in a clinical setting.
Collapse
Affiliation(s)
- Christina Turesson
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Gunilla Liedberg
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
8
|
Kerckhove N, Delage N, Cambier S, Cantagrel N, Serra E, Marcaillou F, Maindet C, Picard P, Martiné G, Deleens R, Trouvin AP, Fourel L, Espagne-Dubreuilh G, Douay L, Foulon S, Dufraisse B, Gov C, Viel E, Jedryka F, Pouplin S, Lestrade C, Combe E, Perrot S, Perocheau D, De Brisson V, Vergne-Salle P, Mertens P, Pereira B, Djiberou Mahamadou AJ, Antoine V, Corteval A, Eschalier A, Dualé C, Attal N, Authier N. eDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study. JMIR Form Res 2022; 6:e30052. [PMID: 35234654 PMCID: PMC8928045 DOI: 10.2196/30052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. OBJECTIVE We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. METHODS We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. RESULTS Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. CONCLUSIONS This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. TRIAL REGISTRATION ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694.
Collapse
Affiliation(s)
- Nicolas Kerckhove
- Service de Pharmacologie médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Noémie Delage
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Sébastien Cambier
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathalie Cantagrel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Eric Serra
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Fabienne Marcaillou
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Caroline Maindet
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Pascale Picard
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Gaelle Martiné
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Rodrigue Deleens
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Anne-Priscille Trouvin
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Lauriane Fourel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Régional de Bayeux, Bayeux, France
| | - Gaelle Espagne-Dubreuilh
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Ludovic Douay
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Stéphane Foulon
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Bénédicte Dufraisse
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Christian Gov
- Centre d'évaluation et de traitement de la douleur, Hospices Civils de Lyon Pierre Wertheimer, Lyon, France
| | - Eric Viel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - François Jedryka
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Sophie Pouplin
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Cécile Lestrade
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuel Combe
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Serge Perrot
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Dominique Perocheau
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Valentine De Brisson
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Régional de Bayeux, Bayeux, France
| | - Pascale Vergne-Salle
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Patrick Mertens
- Centre d'évaluation et de traitement de la douleur, Hospices Civils de Lyon Pierre Wertheimer, Lyon, France
| | - Bruno Pereira
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Violaine Antoine
- Laboratoire d'Informatique, de Modélisation et d'Optimisation des Systèmes, Université Clermont Auvergne, Aubière, France
| | | | | | - Christian Dualé
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nadine Attal
- Institut National de la Santé et de la Recherche Médicale, Unité 987 - Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Ambroise Paré, Paris, France
| | - Nicolas Authier
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| |
Collapse
|
9
|
Kelly M, Fullen B, Martin D, McMahon S, McVeigh JG. eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, "eHealth: It's TIME"-A Scoping Review. Phys Ther 2022; 102:6506314. [PMID: 35079826 PMCID: PMC8994513 DOI: 10.1093/ptj/pzab307] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE eHealth-mediated interventions have been proposed as one option to support self-management in those with musculoskeletal disorders (MSDs). This scoping review aimed to chart the evidence regarding eHealth modalities, musculoskeletal diagnosis, and outcomes of eHealth-mediated self-management support interventions in persons with MSDs and identify any gaps within the literature. METHODS Six electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Database of Systematic Reviews), 7 grey literature sources (eg, OpenGrey), and reference and citation lists of included studies were searched from database inception to July 2020. Published studies of adult participants with a MSD utilizing an eHealth intervention to support self-management were included. Studies were limited to those published in English. Two reviewers independently screened all studies. Data were extracted by 1 reviewer and reviewed by another reviewer. RESULTS After screening 3377 titles and abstracts followed by 176 full texts, 87 studies fulfilled the eligibility criteria. The majority were published in the last 5 years (n = 48; 55%), with almost one-third originating in the United States (n = 28; 32%). The most common eHealth modality type was internet based (n = 22; 35%), with almost one-half (n = 41; 47%) of the included studies involving participants with widespread musculoskeletal symptoms. The most commonly reported outcomes were related to body functions (ie, pain intensity) (n = 67; 45%), closely followed by activities and participation (ie, function) (n = 65; 44%), with environmental factors (ie, health care utilization) the least commonly reported (n = 17; 20%). CONCLUSIONS There is considerable variation within the eHealth-mediated self-management support intervention literature. Research is needed on the role of eHealth-mediated self-management support interventions across a broad range of MSDs to guide clinical practice. IMPACT This scoping review has identified gaps in the literature relating to specific eHealth modalities, musculoskeletal diagnoses, and health care utilization data, which should guide future research.
Collapse
Affiliation(s)
- Marie Kelly
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland,Department of Physiotherapy, Mercy University Hospital, Cork, Ireland,Address all correspondence to Marie Kelly at:
| | - Brona Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom,NIHR Applied Research Collaborative, North East and North Cumbria, United Kingdom
| | - Sinéad McMahon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| |
Collapse
|
10
|
Common reported barriers and facilitators for self-management in adults with chronic musculoskeletal pain: A systematic review of qualitative studies. Musculoskelet Sci Pract 2021; 56:102433. [PMID: 34416557 DOI: 10.1016/j.msksp.2021.102433] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Self-management strategies are considered a necessary component of chronic musculoskeletal pain management to address ongoing symptoms and challenges. However uptake of self-management can be impeded by a number of factors. OBJECTIVES The aim of this study was to explore common impeding and facilitating factors of self-management strategies from the patient perspective. METHODS An electronic search was performed between 2009 to May 2020 for the following databases: MEDLINE, AMED, PsychINFO, Cochrane Library, PubMed, CINAHL, PEDro, and Google Scholar. The search terms included peer-reviewed qualitative or mixed-method studies investigating the perspective of chronic musculoskeletal pain patients in regards to the use of self-management strategies. Study rigor and bias was assessed using the CASP (Critical Appraisal Skills Programme) questionnaire specific to qualitative studies. Qualitative data was coded using a three-stage thematic synthesis process. Confidence in findings was assessed using CERQual (The Confidence in the Evidence from Review of Qualitative Research). RESULTS Twenty-seven studies were included with 487 participants. Six major themes were identified and divided into external and internal influencing factors. The external influencing factors were made up of the following three themes: health care practitioner role, supportive environment, accessibility. While the three internal influencing themes were: physical factors, knowledge and understanding, and psychological factors. CONCLUSION Learning to self-manage for patients in chronic pain required ongoing support either from healthcare practitioners or from social circles. To further assist the self-management process practitioners can improve self-efficacy through increasing patient knowledge of chronic pain, utilising goal setting and finding ways an individual can access ongoing support, either from the practitioner or through group programs.
Collapse
|
11
|
O'Brien M. Pain coping skills training un-locks patient-centered pain care during the COVID- 19 lockdown. Pain Manag Nurs 2021; 23:504-516. [PMID: 34952797 PMCID: PMC8580817 DOI: 10.1016/j.pmn.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In 2020, the COVID-19 virus sparked a crisis constituting a nationwide public health emergency that rapidly altered the provision of healthcare services for all Americans. Infectious disease mitigation led to widespread lockdowns of perceived nonessential services, programs, and non-emergent healthcare interventions. This lockdown exacerbated the public health dyad of uncontrolled pain and the opioid epidemic, which was already in a crisis state. Current literature supports the management of uncontrolled pain with a biopsychosocial approach, empowering patients to explore self-care to enhance activities of daily living. Pain Coping Skills Training (PCST) delivers real-life strategies that improve quality of life and strengthen self-efficacy. Self-efficacy has been identified as a patient outcome measure that demonstrates improved patient-perceived function and quality of life despite pain intensity. Studies have shown that nurse practitioners (APRN) are well-positioned to provide PCST to chronic pain sufferers. METHODS A pretest-posttest design was utilized for this project to enhance pain self- efficacy through an APRN-led community-based intervention. INTERVENTION Community-dwelling adults treated in a specialty pain management practice were self-selected to participate in a 6-week telehealth delivered PCST Program. This APRN delivered program presented basic pain education and a broad range of evidence-based nonpharmacologic pain management self-care tools. The primary outcome was improved Pain Self-efficacy measured with the pain self-efficacy questionnaire (PSEQ), with secondary outcomes of improved perceived pain intensity and function measured with the pain, enjoyment, and general activity (PEG) scale tracked weekly. RESULTS Baseline PSEQ and weekly PEG scores were obtained and compared to scores after the program. Collateral data points included confidence in using complementary and alternative nonpharmacologic interventions, satisfaction with the program, and a qualitative patient statement regarding pre-and post-intervention participation. CONCLUSIONS This project concluded that a Nurse Practitioner delivered PCST program via telehealth technology could provide community-dwelling adults with an intervention that improves pain self-efficacy, enhances self-reported PEG measures, and meets the social distancing requirements that continue to impact patients during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Marie O'Brien
- Wilmington University, Wilmington, DE; Coordinator Integrative Pain Management Program, Mather Hospital Northwell Health, Port Jefferson, NY.
| |
Collapse
|
12
|
The Pain Course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program. Pain 2021; 163:1388-1401. [PMID: 34609359 DOI: 10.1097/j.pain.0000000000002507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is interest in the potential of Internet-delivered programs to cost-effectively increase access to pain management for people with chronic pain. However, few large-scale clinical and economic evaluations have been undertaken. Using a randomised controlled trial design, the current study (n = 659) examined the clinical efficacy, cost-effectiveness, and cost utility of an Internet-delivered pain management program for people with mixed chronic pain conditions when delivered with optional clinician support. The treatment group reported significant improvements in disability, depression, anxiety, average pain intensity, and quality-adjusted life years (QALYs), compared with control, and exhibited relatively high levels of treatment engagement and satisfaction. Each additional clinical improvement (defined as ≥ 30% improvement) produced by the intervention, over control, was associated with a cost of $48, $27, $38, and $83 for disability, depression, anxiety, and average pain intensity, respectively. Gaining one QALY was associated with a cost of $152 or $11,910 per QALY when an 80% probability criterion for cost utility was applied. The program itself was associated a relatively small, fixed, cost per patient but was not cost saving over the brief intervention period. The findings support the clinical efficacy and cost-effectiveness of Internet-delivered programs with "on demand" clinician support as a way to increase access to pain management. Key limitations of the current study include the use of a waitlist-control group, a short follow-up period, and the focus on governmental healthcare costs. Further evaluation of these programs is necessary if they are scaled up and offered as routine care.
Collapse
|
13
|
Hadjistavropoulos HD, Peynenburg V, Thiessen D, Schneider LH, Nugent M, Wilhelms A, Karin E, Titov N, Dear BF. Five-year observational study of Internet-delivered cognitive behavioural pain management when offered as routine care by an online therapy clinic. Eur J Pain 2021; 26:390-404. [PMID: 34592026 PMCID: PMC9293405 DOI: 10.1002/ejp.1866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Internet-delivered cognitive behavioural pain management programmes (PMPs) are effective, but less is known about their use outside of research trials. Five years of data from offering the Internet-delivered cognitive behavioural PMP in an online therapy clinic was examined to assess effectiveness, acceptability and predictors of outcomes. METHODS Patients (N = 293) were offered a previously validated 8-week Internet-delivered cognitive behavioural PMP and administered measures at pre-treatment, post-treatment and 3 months. RESULTS There was growth in demand for an Internet-delivered cognitive behavioural PMP over time (n = 64 first year to n = 133 fifth year). Moderate-to-large improvements on depression (post-treatment 35% reduction; 3-month 41% reduction) and anxiety (post-treatment 37% reduction; 3-month 41% reduction), and small-to-moderate improvements on disability (post-treatment 19% reduction; 3-month 20% reduction) were found. Lesson completion and satisfaction were high. Lower pain acceptance, lower pain self-efficacy and higher pain intensity were associated with lower improvements on depression, anxiety and disability. CONCLUSIONS This longitudinal observational study provides support for Internet-delivered cognitive behavioural PMPs when offered as routine care by an online therapy clinic. SIGNIFICANCE This 5-year observational study provides support for Internet-delivered cognitive behavioural pain management programs (PMPs) offered as routine care in an online therapy clinic. Interest in the service grew over 5 years. Outcomes, engagement and satisfaction were strong. Higher pain acceptance, pain self-efficacy and lower pain severity were associated with greater post-treatment improvements on depression, anxiety and disability.
Collapse
Affiliation(s)
| | - Vanessa Peynenburg
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - David Thiessen
- Department of Mathematics & Statistics, University of Regina, Saskatchewan, Canada
| | - Luke H Schneider
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Marcie Nugent
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Andrew Wilhelms
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Eyal Karin
- Department of Psychology, MindSpot Clinic and eCentreClinic, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- Department of Psychology, MindSpot Clinic and eCentreClinic, Macquarie University, Sydney, Australia
| | - Blake F Dear
- Department of Psychology, MindSpot Clinic and eCentreClinic, Macquarie University, Sydney, Australia
| |
Collapse
|
14
|
Renfrew ME, Morton DP, Morton JK, Przybylko G. The Influence of Human Support on the Effectiveness of Digital Mental Health Promotion Interventions for the General Population. Front Psychol 2021; 12:716106. [PMID: 34489818 PMCID: PMC8416605 DOI: 10.3389/fpsyg.2021.716106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Mental wellbeing amongst the general population is languishing—exacerbated by the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health promotion interventions, that improve mental health literacy and encourage adoption of evidence-informed practical strategies are essential. However, attrition and non-adherence are problematic in digital interventions. Human support is often applied as an antidote; yet, there is a paucity of randomized trials that compare different human support conditions amongst general population cohorts. Limited trials generally indicate that human support has little influence on adherence or outcomes in DMHPIs. However, providing participants autonomy to self-select automated support options may enhance motivation and adherence.
Collapse
Affiliation(s)
- Melanie Elise Renfrew
- Lifestyle Medicine and Health Research Center, Avondale University College, Cooranbong, NSW, Australia
| | - Darren Peter Morton
- Lifestyle Medicine and Health Research Center, Avondale University College, Cooranbong, NSW, Australia
| | - Jason Kyle Morton
- Lifestyle Medicine and Health Research Center, Avondale University College, Cooranbong, NSW, Australia
| | - Geraldine Przybylko
- Lifestyle Medicine and Health Research Center, Avondale University College, Cooranbong, NSW, Australia
| |
Collapse
|
15
|
Palermo TM, Law EF, Topazian MD, Slack K, Dear BF, Ko YJ, Vege SS, Fogel E, Trikudanathan G, Andersen DK, Conwell DL, Yadav D. Internet Cognitive-Behavioral Therapy for Painful Chronic Pancreatitis: A Pilot Feasibility Randomized Controlled Trial. Clin Transl Gastroenterol 2021; 12:e00373. [PMID: 34140460 PMCID: PMC8216675 DOI: 10.14309/ctg.0000000000000373] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Severe abdominal pain is a cardinal symptom of chronic pancreatitis (CP) associated with a high economic and societal burden. In other chronic pain conditions, cognitive-behavioral therapy (CBT) has demonstrated efficacy in improving patient outcomes (e.g., pain-related disability and depression). However, CBT has not yet been evaluated in adult patients with painful CP. We aimed to (i) evaluate the feasibility and acceptability of an adapted Internet CBT program for CP and (ii) generate pilot data regarding the effects of treatment on patient pain outcomes. METHODS Thirty adults (mean age = 49.8 years, SD = 12.5; 80% women) with suspected or definite CP were randomized to Internet CBT (Pancreatitis Pain Course) versus control. The Pancreatitis Pain Course has 5 CBT lessons (e.g., thought challenging, relaxation, and activity pacing) delivered over 8 weeks. Pain interference, pain intensity, and quality of life were assessed at pretreatment, posttreatment, and the 3-month follow-up. Qualitative interviews were conducted at posttreatment with a subset of participants. RESULTS Eighty percent of participants rated the program as highly acceptable; 64.3% completed all 5 lessons. Qualitative data revealed positive perceptions of program features, relevancy, and skills. Patients randomized to Internet CBT demonstrated moderate to large effects in reducing pain intensity and pain interference from baseline to 3 months. The proportion of treatment responders (>30% improvement) was significantly greater in the Internet-CBT group than in the control group (50% vs 13%, Fisher exact t test P = 0.04). DISCUSSION In this first trial of CBT pain self-management in CP, feasibility, acceptability, and preliminary efficacy for reducing pain and disability were demonstrated. Future definitive trials of CBT are needed.
Collapse
Affiliation(s)
- Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine Seattle, Washington, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Emily F. Law
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine Seattle, Washington, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mark D. Topazian
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine Slack
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Blake F. Dear
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Yeon Joo Ko
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Santhi Swaroop Vege
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Evan Fogel
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Guru Trikudanathan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dana K. Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Darwin L. Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University, Columbus, Ohio, USA
| | - Dhiraj Yadav
- Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
16
|
Dear BF, Karin E, Fogliati R, Dudeney J, Nielssen O, Scott AJ, Gandy M, Bisby MA, Heriseanu AI, Hathway T, Staples L, Titov N, Schroeder L. A Cost-effectiveness Analysis of an Internet-delivered Pain Management Program Delivered With Different Levels of Clinician Support: Results From a Randomised Controlled Trial. THE JOURNAL OF PAIN 2020; 22:344-358. [PMID: 33227510 DOI: 10.1016/j.jpain.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
There is growing interest in the potential of internet-delivered pain management programs (PMPs) to increase access to care for people with chronic pain. However, very few economic evaluations of these interventions have been reported. Using existing data, the current study examined the cost-effectiveness of an internet-delivered PMP for a mixed group chronic pain patients (n = 490) provided with different levels of clinician support. The findings indicated that each additional clinical outcome (defined as a ≥ 30% reduction in disability, depression, anxiety, and pain) was associated with cost-savings when the intervention was provided in a self-guided format (ICER range: -$404--$808 AUD) or an optional-guided format (ICER range: -$314--$541 AUD), and a relatively small fixed cost when provided in the clinician-guided format (ICER range: $88-$225 AUD). The results were driven by a reduction in service use costs among the treatment groups, which offset the costs of providing the internet-delivered PMP in the self-guided and optional-guided formats. The same general pattern of results was found when more stringent clinical outcomes (defined as a ≥ 50% reduction) were employed. These findings suggest that carefully developed and administered internet-delivered PMPs, provided with different levels of clinician support, can be highly cost effective for patients with a broad range of pain conditions. PERSPECTIVE: This study examines the cost-effectiveness of an internet-delivered PMP provided to adults with a broad range of chronic pain conditions. Evidence of cost-effectiveness was found across a broad range of clinical outcomes and with different levels of clinician support.
Collapse
Affiliation(s)
- Blake F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Rhiannon Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Joanne Dudeney
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Olav Nielssen
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Amelia J Scott
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Milena Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Madelyne A Bisby
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Andreea I Heriseanu
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Taylor Hathway
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Lauren Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Liz Schroeder
- Centre for Health Economy, Macquarie University, Sydney, Australia
| |
Collapse
|
17
|
Lam J, Svensson P, Alstergren P. Internet-Based Multimodal Pain Program With Telephone Support for Adults With Chronic Temporomandibular Disorder Pain: Randomized Controlled Pilot Trial. J Med Internet Res 2020; 22:e22326. [PMID: 33048053 PMCID: PMC7592067 DOI: 10.2196/22326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Chronic pain from temporomandibular disorders remains an undertreated condition with debate regarding the most effective treatment modalities. OBJECTIVE The aim of the study was to investigate the treatment effect of an internet-based multimodal pain program on chronic temporomandibular disorder pain and evaluate the feasibility of a larger randomized controlled trial. METHODS An unblinded randomized controlled pilot trial was conducted with 43 participants (34 females, 9 males; median age 27, IQR 23-37 years) with chronic temporomandibular pain. Participants were recruited within the Public Dental Health Service and randomized to intervention (n=20) or active control (n=23). The intervention comprised a dentist-assisted internet-based multimodal pain program with 7 modules based on cognitive behavior therapy and self-management principles. The control group received conventional occlusal splint therapy. Primary outcomes included characteristic pain intensity, pain-related disability, and jaw functional limitation. Secondary outcomes were depression, anxiety, catastrophizing, and stress. Outcomes were self-assessed through questionnaires sent by mail at 3 and 6 months after treatment start. Feasibility evaluation included testing the study protocol and estimation of recruitment and attrition rates in the current research setting. RESULTS Only 49% of participants (21/43) provided data at the 6-month follow-up (internet-based multimodal pain program: n=7; control: n=14). Of the 20 participants randomized to the internet-based multimodal pain program, 14 started treatment and 8 completed all 7 modules of the program. Between-group analysis showed no significant difference for any outcome measure at 3- or 6-month follow-up-characteristic pain intensity (3 months: P=.58; 6 months: P=.41), pain-related disability (3 months: P=.51; 6 months: P=.12), jaw functional limitation (3 months: P=.45; 6 months: P=.90), degree of depression (3 months: P=.64; 6 months: P=.65), anxiety (3 months: P=.93; 6 months: P=.31), stress (3 months: P=.66; 6 months: P=.74), or catastrophizing (3 months: P=.86; 6 months: P=.85). Within-group analysis in the internet-based multimodal pain program group showed a significant reduction in jaw functional limitation score at the 6-month follow-up compared to baseline (Friedman: χ2=10.2, P=.04; Wilcoxon: z=-2.3, P=.02). In the occlusal splint group, jaw function limitation was also reduced at the 6-month follow-up (Friedman: χ2=20.0, P=.045; Wilcoxon: z=-2.3, P=.02), and there was a reduction in characteristic pain intensity at the 3- and 6-month follow-up (Friedman: χ2=25.1, P=.01; Wilcoxon 3 months: z=-3.0, P=.003; Wilcoxon 6 months: z=-3.3, P=.001). CONCLUSIONS This study was not able to demonstrate a difference in treatment outcome between an internet-based multimodal pain program and occlusal splint therapy in patients with chronic temporomandibular pain. However, the findings suggested that the internet-based multimodal pain program improves jaw function. The results also confirmed the treatment effect of occlusal splint therapy for chronic temporomandibular pain. Furthermore, because of the high attrition rate, this pilot study showed that a randomized controlled trial with this design is not feasible. TRIAL REGISTRATION ClinicalTrials.gov NCT04363762; https://clinicaltrials.gov/show/NCT04363762.
Collapse
Affiliation(s)
- Julia Lam
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö, Sweden.,Folktandvården Skåne AB, Hässleholm and Lund, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden
| | - Peter Svensson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Department of Orofacial Pain and Jaw Function, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Per Alstergren
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden.,Specialized Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
18
|
Out of office hours: scalable, on-demand, digital support for patients tapering prescription opioids. Pain 2020; 161:2252-2254. [PMID: 32501860 DOI: 10.1097/j.pain.0000000000001947] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
19
|
Renfrew ME, Morton DP, Morton JK, Hinze JS, Przybylko G, Craig BA. The Influence of Three Modes of Human Support on Attrition and Adherence to a Web- and Mobile App-Based Mental Health Promotion Intervention in a Nonclinical Cohort: Randomized Comparative Study. J Med Internet Res 2020; 22:e19945. [PMID: 32990633 PMCID: PMC7556377 DOI: 10.2196/19945] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/22/2020] [Accepted: 08/03/2020] [Indexed: 12/21/2022] Open
Abstract
Background The escalating prevalence of mental health disorders necessitates a greater focus on web- and mobile app–based mental health promotion initiatives for nonclinical groups. However, knowledge is scant regarding the influence of human support on attrition and adherence and participant preferences for support in nonclinical settings. Objective This study aimed to compare the influence of 3 modes of human support on attrition and adherence to a digital mental health intervention for a nonclinical cohort. It evaluated user preferences for support and assessed whether adherence and outcomes were enhanced when participants received their preferred support mode. Methods Subjects participated in a 10-week digital mental health promotion intervention and were randomized into 3 comparative groups: standard group with automated emails (S), standard plus personalized SMS (S+pSMS), and standard plus weekly videoconferencing support (S+VCS). Adherence was measured by the number of video lessons viewed, points achieved for weekly experiential challenge activities, and the total number of weeks that participants recorded a score for challenges. In the postquestionnaire, participants ranked their preferred human support mode from 1 to 4 (S, S+pSMS, S+VCS, S+pSMS & VCS combined). Stratified analysis was conducted for those who received their first preference. Preintervention and postintervention questionnaires assessed well-being measures (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing). Results Interested individuals (N=605) enrolled on a website and were randomized into 3 groups (S, n=201; S+pSMS, n=202; S+VCS, n=201). Prior to completing the prequestionnaire, a total of 24.3% (147/605) dropped out. Dropout attrition between groups was significantly different (P=.009): 21.9% (44/201) withdrew from the S group, 19.3% (39/202) from the S+pSMS
group, and 31.6% (64/202) from the S+VCS group. The remaining 75.7% (458/605) registered and completed the prequestionnaire (S, n=157; S+pSMS, n=163; S+VCS, n=138). Of the registered participants, 30.1% (138/458) failed to complete the postquestionnaire (S, n=54; S+pSMS, n=49; S+VCS, n=35), but there were no between-group differences (P=.24). For the 69.9% (320/458; S, n=103; S+pSMS, n=114; S+VCS, n=103) who completed the postquestionnaire, no between-group differences in adherence were observed for mean number of videos watched (P=.42); mean challenge scores recorded (P=.71); or the number of weeks that challenge scores were logged (P=.66). A total of 56 participants (17.5%, 56/320) received their first preference in human support (S, n=22; S+pSMS, n=26; S+VCS, n=8). No differences were observed between those who received their first preference and those who did not with regard to video adherence (P=.91); challenge score adherence (P=.27); or any of the well-being measures including, mental health (P=.86), vitality (P=.98), depression (P=.09), anxiety (P=.64), stress (P=.55), life satisfaction (P=.50), and flourishing (P=.47). Conclusions Early dropout attrition may have been influenced by dissatisfaction with the allocated support mode. Human support mode did not impact adherence to the intervention, and receiving the preferred support style did not result in greater adherence or better outcomes. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx
Collapse
Affiliation(s)
- Melanie Elise Renfrew
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| | - Darren Peter Morton
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| | - Jason Kyle Morton
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| | - Jason Scott Hinze
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| | - Geraldine Przybylko
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| | - Bevan Adrian Craig
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| |
Collapse
|
20
|
Walker P, De Morgan S, Sanders D, Nicholas M, Blyth FM. Primary care initiatives focused on the secondary prevention and management of chronic pain: a scoping review of the Australian literature. Aust J Prim Health 2020; 26:273-280. [PMID: 32669195 DOI: 10.1071/py20092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
The aim of this scoping review was to identify initiatives focused on the secondary prevention and management of chronic pain in Australian primary care to understand options available to Primary Health Networks and to identify evidence gaps. The Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature and Cochrane databases, as well as relevant websites, were searched for eligible records published from 2007 to 2018. Initiative characteristics and outcomes evaluated were extracted and synthesised. In all, 84 initiatives from 167 published and grey literature records were identified, including: (1) consumer initiatives that aimed to improve access to multidisciplinary care, health literacy and care navigation (n=56); (2) health professional capacity building initiatives that aimed to ensure health professionals are skilled and provide best-practice evidence-based care (n=21); and (3) quality improvement and health system support initiatives (n=7). Evidence gaps were found relating to initiatives addressing the secondary prevention of chronic pain, those targeting vulnerable and regional populations, health professional capacity building initiatives for all primary health care providers and quality improvement and system support initiatives. Addressing evidence gaps related to effectiveness, cost-effectiveness and implementation should be the focus for future chronic pain initiatives in primary care settings.
Collapse
Affiliation(s)
- Pippy Walker
- The Australian Prevention Partnership Centre and Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW 2006, Australia; and Corresponding author.
| | - Simone De Morgan
- The Australian Prevention Partnership Centre and Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW 2006, Australia
| | - Duncan Sanders
- Pain Management Research Institute, Sydney Medical School - Northern, Faculty of Medicine and Health, University of Sydney, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Michael Nicholas
- Pain Management Research Institute, Sydney Medical School - Northern, Faculty of Medicine and Health, University of Sydney, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building A27, Camperdown, NSW 2006, Australia
| |
Collapse
|
21
|
Higgins DM, Buta E, Williams DA, Halat A, Bair MJ, Heapy AA, Krein SL, Rajeevan H, Rosen MI, Kerns RD. Internet-Based Pain Self-Management for Veterans: Feasibility and Preliminary Efficacy of the Pain EASE Program. Pain Pract 2020; 20:357-370. [PMID: 31778281 DOI: 10.1111/papr.12861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To develop and test the feasibility and preliminary efficacy of a cognitive behavioral therapy-based, internet-delivered self-management program for chronic low back pain (cLBP) in veterans. METHODS Phase I included program development, involving expert panel and participant feedback. Phase II was a single-arm feasibility and preliminary efficacy study of the Pain e-health for Activity, Skills, and Education (Pain EASE) program. Feasibility (ie, website use, treatment credibility, satisfaction) was measured using descriptive methods. Mixed models were used to assess mean within-subject changes from baseline to 10 weeks post-baseline in pain interference (primary outcome, West Haven-Yale Multidimensional Pain Inventory, scale of 0 to 6), pain intensity, mood, fatigue, sleep, and depression. RESULTS Phase I participants (n = 15) suggested modifications including style changes, content reduction, additional "Test Your Knowledge" quizzes, and cognitive behavioral therapy skill practice monitoring form revisions for enhanced usability. In Phase II, participants (n = 58) were mostly male (93%) and White (60%), and had an average age of 55 years (standard deviation [SD] = 12) and moderate pain (mean score 5.9/10); 41 (71%) completed the post-baseline assessment. Participants (N = 58) logged on 6.1 (SD = 8.6) times over 10 weeks, and 85% reported being very or moderately satisfied with Pain EASE. Pain interference improved from a mean of 3.8 at baseline to 3.3 at 10 weeks (difference 0.5 [95% confidence interval 0.1 to 0.9], P = 0.008). Within-subject improvement also occurred for some secondary outcomes, including mood and depression symptoms. DISCUSSION Veterans with cLBP may benefit from technology-delivered interventions, which may also reduce pain interference. Overall, veterans found that Pain EASE, an internet-based self-management program, is feasible and satisfactory for cLBP.
Collapse
Affiliation(s)
- Diana M Higgins
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Eugenia Buta
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | | | - Allison Halat
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Matthew J Bair
- VA Health Services Research and Development, Center for Health Information and Communication (CHIC), Indianapolis, IN.,Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN
| | - Alicia A Heapy
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Sarah L Krein
- University of Michigan Medical School, Ann Arbor, MI.,VA Ann Arbor Center for Clinical Management Research Health Services Research and Development Center of Innovation, Ann Arbor, MI
| | | | - Marc I Rosen
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | | |
Collapse
|
22
|
Mariano TY, Wan L, Edwards RR, Jamison RN. Online teletherapy for chronic pain: A systematic review. J Telemed Telecare 2019; 27:195-208. [PMID: 31488004 DOI: 10.1177/1357633x19871746] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE A systematic review designed to evaluate the benefits of remote group pain management for persons with chronic pain was performed. METHODS PubMed, EMBASE and PsychINFO databases were searched in April 2019. Eligible studies evaluated teletherapy for chronic pain based on set inclusion and exclusion criteria. Two reviewers independently screened eligible studies, assessed risk of bias and extracted data. Each study design was rated and study quality was assessed using an 11-point scale of methodological quality. RESULTS Comprehensive searches identified 12 studies that met all inclusion/exclusion criteria and each study was assessed for type of technology, study design, outcome measures, study findings and limitations. No published studies investigated synchronous teletherapy for groups of chronic pain patients. Methods of assessment varied considerably across studies. Strength of evidence was moderate and many of the selected studies had issues with treatment compliance/adherence and selection bias. Teletherapy strategies for persons with chronic pain were shown to improve pain, mood, disability and catastrophising, however half of the studies selected did not meet the criteria for acceptable standards for internal validity. Those trials with limited therapist involvement appeared to be less beneficial and tended to report lower adherence than those which had higher levels of therapist guidance or peer support. CONCLUSIONS Preliminary findings suggest that teletherapy and remote online cognitive behavioural therapy strategies can be effective in improving quality of life among persons with chronic pain, although the overall quality of evidence is moderate. Controlled trials are needed to assess live remote teletherapy for chronic pain.
Collapse
Affiliation(s)
- Timothy Y Mariano
- Department of Psychiatry, Brigham and Women's Hospital, USA.,Harvard Medical School, USA.,Butler Hospital, USA.,Providence Veterans Affairs Medical Center, USA
| | - Limeng Wan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, USA
| | - Robert R Edwards
- Department of Psychiatry, Brigham and Women's Hospital, USA.,Harvard Medical School, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, USA
| | - Robert N Jamison
- Department of Psychiatry, Brigham and Women's Hospital, USA.,Harvard Medical School, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, USA
| |
Collapse
|
23
|
Narayan SW, Pearson SA, Litchfield M, Le Couteur DG, Buckley N, McLachlan AJ, Zoega H. Anticholinergic medicines use among older adults before and after initiating dementia medicines. Br J Clin Pharmacol 2019; 85:1957-1963. [PMID: 31046175 PMCID: PMC6710547 DOI: 10.1111/bcp.13976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS We investigated anticholinergic medicines use among older adults initiating dementia medicines. METHODS We used Pharmaceutical Benefits Scheme dispensing claims to identify patients who initiated donepezil, rivastigmine, galantamine or memantine between 1 January 2013 and 30 June 2017 (after a period of ≥180 days with no dispensing of these medicines) and remained on therapy for ≥180 days (n = 4393), and dispensed anticholinergic medicines in the 180 days before and after initiating dementia medicines. We further examined anticholinergic medicines prescribed by a prescriber other than the one initiating dementia medicines. RESULTS One-third of the study cohort (1439/4393) was exposed to anticholinergic medicines up to 180 days before or after initiating dementia medicines. Among patients exposed to anticholinergic medicines, 46% (659/1439) had the same medicine dispensed before and after initiating dementia medicines. The proportion of patients dispensed anticholinergic medicines increased by 2.5% (95% confidence interval [CI]: 1.3-3.7) after initiating dementia medicines. Antipsychotics use increased by 10.1% (95% CI: 7.6-12.7) after initiating dementia medicines; driven by increased risperidone use (7.3%, 95% CI: 5.3-9.3). Nearly half of patients dispensed anticholinergic medicines in the 180 days after (537/1133), were prescribed anticholinergic medicines by a prescriber other than the one initiating dementia medicines. CONCLUSION Use of anticholinergic medicines is common among patients initiating dementia medicines and this occurs against a backdrop of widespread campaigns to reduce irrational medicine combinations in this vulnerable population. Decisions about deprescribing medicines with questionable benefit among patients with dementia may be complicated by conflicting recommendations in prescribing guidelines.
Collapse
Affiliation(s)
- Sujita W Narayan
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Melisa Litchfield
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - David G Le Couteur
- Centre for Education and Research in Ageing, Concord Hospital, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Nicholas Buckley
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Andrew J McLachlan
- Centre for Education and Research in Ageing, Concord Hospital, Sydney, Australia.,Sydney Pharmacy School, The University of Sydney, Sydney, Australia
| | - Helga Zoega
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland
| |
Collapse
|
24
|
Ledel Solem IK, Varsi C, Eide H, Kristjansdottir OB, Mirkovic J, Børøsund E, Haaland-Øverby M, Heldal K, Schreurs KM, Waxenberg LB, Weiss KE, Morrison EJ, Solberg Nes L. Patients' Needs and Requirements for eHealth Pain Management Interventions: Qualitative Study. J Med Internet Res 2019; 21:e13205. [PMID: 30877780 PMCID: PMC6462891 DOI: 10.2196/13205] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A growing body of evidence supports the potential effectiveness of electronic health (eHealth) interventions in managing chronic pain. However, research on the needs and preferences of patients with chronic pain in relation to eHealth interventions is scarce. Eliciting user input in the development of eHealth interventions may be a crucial step toward developing meaningful interventions for patients for potentially improving treatment outcomes. OBJECTIVE This study aimed to explore the experiences of patients with chronic pain with regard to information and communication technology, understand how an eHealth intervention can support the everyday needs and challenges of patients with chronic pain, and identify possible facilitators and barriers for patients' use of an eHealth pain management intervention. METHODS Twenty patients living with chronic pain and five spouses participated in individual interviews. Semistructured interview guides were used to explore participants' needs, experiences, and challenges in daily life as well as their information and communication technology experiences and preferences for eHealth support interventions. Spouses were recruited and interviewed to gain additional insight into the patients' needs. The study used qualitative thematic analysis. RESULTS The participants were generally experienced technology users and reported using apps regularly. They were mainly in favor of using an eHealth self-management intervention for chronic pain and considered it a potentially acceptable way of gathering knowledge and support for pain management. The participants expressed the need for obtaining more information and knowledge, establishing a better balance in everyday life, and receiving support for improving communication and social participation. They provided suggestions for the eHealth intervention content and functionality to address these needs. Accessibility, personalization, and usability were emphasized as important elements for an eHealth support tool. The participants described an ideal eHealth intervention as one that could be used for support and distraction from pain, at any time or in any situation, regardless of varying pain intensity and concentration capacity. CONCLUSIONS This study provides insight into user preferences for eHealth interventions aiming to address self-management for chronic pain. Participants highlighted important factors to be considered when designing and developing eHealth interventions for self-management of chronic pain, illustrating the importance and benefit of including users in the development of eHealth interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104.
Collapse
Affiliation(s)
- Ingrid Konstanse Ledel Solem
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Varsi
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Hilde Eide
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Olöf Birna Kristjansdottir
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Jelena Mirkovic
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Elin Børøsund
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Mette Haaland-Øverby
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Karina Heldal
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karlein Mg Schreurs
- Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
| | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Florida, FL, United States
| | - Karen Elizabeth Weiss
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Washington, WA, United States
| | | | - Lise Solberg Nes
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|