Remote delivery of self-management education workshops for adults with chronic pain, 2020-2021

OBJECTIVES

We intended to assess changes in pain-related outcomes among rural adults who completed 6-week self-management programs offered remotely during the COVID-19 pandemic.

METHODS

We offered the Chronic Pain Self-Management Program and Chronic Disease Self-Management Program between May 2020 and December 2021. Delivery mode options included 2½-hour weekly videoconference, mailed toolkit plus 1-hour weekly conference call, and mailed toolkit alone. We conducted pre- and post-workshop surveys including questions on patient activation, self-efficacy, depression and pain disability. We used paired t-tests to compare pre-post differences in outcomes among participants completing 4 or more sessions.

RESULTS

Among 218 adults reporting chronic pain, mean age was 57; 83.6% were female; and 49.5% participated via videoconference, 23.4% by phone and 27.1% via mailed toolkit alone. Completion rates were higher among phone (88.2%) versus videoconference (60.2%) workshop participants. Among completers, patient activation (mean change  =  3.61, p  =  0.01) and self-efficacy (mean change  =  3.72, p < 0.0001) increased while depression scores (mean change  =  -1.03, p  =  0.01), pain disability (mean change  =  -0.93, p  =  0.003) and pain symptoms (mean change  =  -0.61, p  =  0.001) decreased over the 6-week period.

DISCUSSION

Self-management programs offered remotely during the pandemic were successful in improving patient activation, self-efficacy, depression, pain disability, and pain symptoms among rural adults experiencing chronic pain.

Self-compassion and pain disability in adults with chronic pain: The mediating role of future self-identification and self-efficacy

Pain disability is a primary target of treatment for chronic pain. Self-compassion shows promise as an intervention to reduce pain disability, but mechanisms linking self-compassion with less pain disability remain to be identified. This study examined two potential mechanisms, health self-efficacy and future self-identification (FSI), as parallel mediators of the relation between self-compassion and pain disability. Adults (N = 188; Mage = 40.34, SD = 11.53; 70.9% female) screened for chronic pain were recruited through online convenience sampling. Participants completed self-report measures of demographics, health status, and primary study variables. Self-compassion was positively associated with FSI and self-efficacy, but only self-efficacy was found to mediate the negative relation between self-compassion and pain disability, such that self-compassion was associated with higher self-efficacy, which was associated with less pain disability. Future experimental and longitudinal studies can establish whether the negative relation between self-compassion and pain disability is causal and mediated via health self-efficacy.

Effectiveness of medical rehabilitation in persons with back pain - lessons learned from a German cohort study

PURPOSE

Evidence for health-related effects of German medical rehabilitation programs for back pain is inconclusive. This cohort study aimed to examine the effectiveness of medical rehabilitation in residents with back pain (German Clinical Trial Register: DRKS00011554).

MATERIAL AND METHODS

A sample of 45 000 people aged 45-59 years was randomly drawn from two pension agencies. We used propensity score matching to compare persons with back pain who completed a medical rehabilitation program with similar untreated subjects. Questionnaire data were assessed in 2017 and 2019, and linked with administrative data. The primary outcome was pain disability.

RESULTS

In total, 6610 persons with back pain were considered for matching and we finally compared 200 persons treated in a medical rehabilitation program with 200 untreated subjects. Pain disability was reported more favorable in the control group without medical rehabilitation compared to the intervention group (difference = 4.2; 95% CI -0.8-9.2), as well as other secondary outcomes.

CONCLUSIONS

At first glance, the findings suggest that medical rehabilitation was ineffective in improving health, pain and work ability among employed persons with back pain, but we found plausible explanations indicating that the estimated effects in favor of the untreated subjects are methodologically induced.IMPLICATIONS FOR REHABILITATIONPropensity score matching can be used to assess the effects of multimodal interventions in persons with back pain in routine care.Inappropriate recruitment of controls may underestimate treatment effects.When using observational data and propensity score matching to analyze the effectiveness of medical rehabilitation, baseline survey should be conducted directly before the start of rehabilitation to identify comparable controls.

Relationships Between Cognitive Screening Composite Scores and Pain Intensity and Pain Disability in Adults With/At Risk for Knee Osteoarthritis

OBJECTIVES

Chronic pain, cognitive deficits, and pain-related disability are interrelated. The prevalence of chronic pain and undiagnosed cognitive difficulties in middle age and older adults is increasing. Of the cognitive systems, executive function and episodic memory are most relevant to chronic pain. We examined the hypothesis that cognitive screening composite scores for executive function and memory would negatively associate with pain intensity and pain disability in a group of middle-aged and older adults with knee pain with or at risk for osteoarthritis.

METHODS

A total of 120 adults (44 men/76 women), an average age of 59 years, participated in the study. Demographic, health history, clinical pain, and cognitive measures were completed. Relationships between pain intensity, pain disability, and the Montreal Cognitive Assessment (MoCA) total and composite scores were examined with relevant covariates in the model.

RESULTS

MoCA raw scores ranged from 13 to 30 with a mean score of 23.9. Pain intensity was negatively associated with overall MoCA total and executive function and memory composite scores. Pain disability over the previous 6 months was negatively associated with executive function, while pain disability over the past 48 hours was not associated with executive function.

CONCLUSION

The results of the current study demonstrates associations between pain metrics and cognitive domain scores within a common cognitive screening tool.

Evaluation of a Peer Led Chronic Pain Self-Management Program in a Rural Population

BACKGROUND

The Chronic Pain Self-Management Program is an evidence-based intervention that has been shown to be efficacious in reducing symptoms of chronic pain. However, there is a paucity of research examining CPSMP in a predominantly rural population. The purpose was to evaluate patient-reported outcomes of in-person peer-led CPSMP workshops offered in a rural region in 2018 and 2019.

METHODS

Participants were surveyed at baseline and 6 months post-workshop. Descriptive statistics were used to describe characteristics of CPSMP completers. Paired t-tests were used to analyze change in depression score (PHQ-8), disability (modified Roland-Morris Disability Questionnaire), self-efficacy, and patient activation (PAM-10). Analysis of variance was used to detect differences over time by age group, education, insurance type, self-rated health, and comorbidities.

RESULTS

Among the 327 adults who enrolled in a workshop, 73.1% completed. Of completers, 74.9% were female, average age was 65. Significant improvements were observed in pain disability (P = .0008), patient activation (P = .0362), depression (P < .0001), and self-efficacy (P < .0001), at 6 weeks; and pain disability (P = .0030), depression (P = .0015), and self-efficacy (P = .0064) at 6 months post-program. Individuals who rated their health as fair/poor at baseline reported greater improvements in depression scores than individuals who rated their health as good or better (P < .0002). There were also distinct patterns of change in pain disability among the different age groups. No other differences between groups were noted.

CONCLUSIONS

The CPSMP appears to improve pain self-efficacy, disability, and depression regardless of age, gender, insurance status, education, or comorbidities. Healthcare and community organizations should consider investing in and offering chronic pain workshops in rural areas in order to promote health and wellness.

Cooled radiofrequency for the treatment of sacroiliac joint pain - impact on pain and psychometrics: a retrospective cohort study

Objectives Cooled radiofrequency (cRF) is an effective treatment for sacroiliac pain. In contrast to conventional radiofrequency denervation, this technique allows enlarging the area of denervation by cooling the radiofrequency probe. However, there is sparse knowledge about the impact of interventional procedures like cRF treatment of sacroiliac joint pain on psychological comorbidities. The aim of this retrospective study was to evaluate the outcome of cRF in chronic pain patients regarding the psychological outcomes anxiety, depression, sleep quality and pain related disability. Methods In this retrospective observational study 29 interventions were performed over a period of two years in 28 patients. Pre- and post-interventional pain levels, depression and anxiety scores, pain-related disability, treatment satisfaction and sleep quality were assessed by standardized and validated questionnaires. Pain medication was recorded prior to the intervention and at follow-up. Results Hospital Anxiety and Depression Scale (HADS-D) scores for depression showed a statistically significant reduction after therapy which did not remain significant after Bonferroni-Holm correction. Anxiety as measured by the HADS-A score did not show a statistically significant change. No statistically significant improvement was observed in the pain disability index. Patients reported fewer sleep disorders after treatment. Mean pain (NRS) was statistically significantly reduced 1 week post intervention and at time of follow-up. There was no clear reduction of analgesic medication. Conclusions Besides pain reduction, our data show a positive influence on sleep quality, possibly on depression, but not on anxiety and pain disability.

Above and beyond emotional suffering: the unique contribution of compassionate and uncompassionate self-responding in chronic pain

Objectives Studies have shown that self-compassion plays a protective role against depression in women with chronic pain (CP). However, the majority of studies in CP have used the total score of the self-compassion scale (SCS), which have raised concerns due to potential overlap, not only between the uncompassionate self-responding factors and psychopathology, but also between self-compassion as a whole and other well-known psychological processes (e.g., mindfulness, acceptance, psychological flexibility). This calls for a more nuanced understanding of which components of (un)compassionate self-responding adds to better mental health in CP. Methods This study explores the unique contribution of compassionate and uncompassionate self-responding to depressive symptoms in women with CP undergoing pain consultation (n = 49). Results Correlation analyses suggest that compassionate self-responding only significantly correlates with progress in valued living, while the uncompassionate self-responding significantly correlates with pain fusion, pain avoidance, obstructions to valued living and depression. Multiple regression analysis showed that self-compassion contributes to depressive symptoms (R2 = 8%) above and beyond pain intensity and disability (R2 = 12%) and psychological (in) flexibility processes (R2 = 31%), and uncompassionate (but not compassionate) self-responding uniquely contributes to depressive symptoms (sr 2  = 18%). Conclusions Findings suggest that uncompassionate self-responding is a stronger contributor to depression in CP than compassionate self-responding. Clinical implications are further discussed.

Cupping for Patients With Chronic Pain: A Systematic Review and Meta-Analysis

There is a growing interest in nonpharmacological pain treatment options such as cupping. This meta-analysis aimed to assess the effectiveness and safety of cupping in chronic pain. PubMed, Cochrane Library, and Scopus were searched through November 2018 for randomized controlled trials on effects of cupping on pain intensity and disability in patients with chronic pain. Risk of bias was assessed using the Cochrane risk of bias tool. Of the 18 included trials (n =1,172), most were limited by clinical heterogeneity and risk of bias. Meta-analyses found large short-term effects of cupping on pain intensity compared to no treatment (standardized mean difference [SMD] = -1.03; 95% confidence interval [CI] = -1.41, -.65), but no significant effects compared to sham cupping (SDM = -.27; 95% CI = -.58, .05) or other active treatment (SMD = -.24; 95% CI = -.57, .09). For disability, there were medium-sized short-term effects of cupping compared to no treatment (SMD = -.66; 95% CI = -.99, -.34), and compared to other active treatments (SMD = -.52; 95% CI = -1.03, -.0028), but not compared to sham cupping (SMD = -.26; 95% CI = -.57,.05). Adverse events were more frequent among patients treated with cupping compared to no treatment; differences compared to sham cupping or other active treatment were not statistically significant. Cupping might be a treatment option for chronic pain, but the evidence is still limited by the clinical heterogeneity and risk of bias. Perspective: This article presents the results of a meta-analysis aimed to assess the effectiveness and safety of cupping with chronic pain. The results suggest that cupping might be a treatment option; however, the evidence is still limited due to methodical limitations of the included trials. High-quality trials seem warranted.

Distress tolerance and pain experience among young adults

Pain and pain related problems affect a significant proportion of the United States population. Past research suggests that emotional distress is associated with more severe and disabling pain experience. Yet, it is less clear how individual reactions to distress are related to pain experience. Distress tolerance, defined as the perceived ability to withstand cognitive, affective, or physical distress, is an individual difference factor that may be particularly important to understanding the experience of pain. The current study examined the association of distress tolerance with pain severity, pain disability, and frequency of pain disability in a sample of young adults (N = 1577, M _age = 22.17) with mild to severe pain. Results indicated that, after controlling for gender, past 30-day opiate use, and perceived health status, lower distress tolerance was significantly associated with more severe and disabling pain. These novel empirical findings suggest distress tolerance may be a useful construct in need of further study among young adults with pain complaints.

Pain, psychosocial tests, pain sensitization and laparoscopic pelvic surgery

BACKGROUND AND AIMS

Individuals with non-acute pain are challenged with variable pain responses following surgery as well as psychological challenges, particularly depression and catastrophizing. The purpose of this study was to compare pre- and postoperative psychosocial tests and the associated presence of sensitization on a cohort of women undergoing elective laparoscopic surgery for non-acute pain defined as pain sufficient for surgical investigation without persistent of chronic pain.

METHODS

The study was a secondary analysis of a previous report (Am J Obstet Gynecol 2014 Oct;211(4):360-8.). The study was a prospective cohort trial of 77 women; 61 with non-acute pain and 16 women for a tubal ligation. The women had the following tests: Pain Disability Index, Pain Catastrophizing Scale, CES-D (Center for Epidemiologic Studies Depression Scale) depression scale and the McGill Pain Scale (short form) as well as their average pain score and the presence of pain sensitization. All test scores were correlated together and comparisons were done using paired t-test.

RESULTS

There were reductions in pain and psychosocial test scores that were significantly correlated. Pre-operative sensitization indicated greater changes in psychosocial tests.

CONCLUSIONS

There was a close association of tests of psychosocial status with average pain among women having surgery on visceral tissues. Incorporation of these tests in the pre- and postoperative evaluation of women having laparoscopic surgery appears to provide a means to a broader understanding of the woman's pain experience.

A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents: Effects of Acceptance and Commitment Therapy on Functioning

Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT) have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions), including a parent support program (four sessions). Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12) or individual (n = 18) treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p < 0.01) improvements (medium to large effects) in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01) improvements (large effects) in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%–63% of the adolescents across the different outcome measures and in 54%–76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.

Chronic postsurgical pain and persistent opioid use following surgery: the need for a transitional pain service

AIM

To identify the 3-month incidence of chronic postsurgical pain and long-term opioid use in patients at the Toronto General Hospital.

METHODS

200 consecutive patients presenting for elective major surgery completed standardized questionnaires by telephone at 3 months after surgery.

RESULTS

51 patients reported a preoperative chronic pain condition, with 12 taking opioids preoperatively. 3 months after surgery 35% of patients reported having surgical site pain and 13.5% continued to use opioids for postsurgical pain relief. Postoperative opioid use was associated with interference with walking and work, and lower mood.

CONCLUSION

Chronic postsurgical pain and ongoing opioid use are concerns that warrant the implementation of a Transitional Pain Service to modify the pain trajectories and enable effective opioid weaning following major surgery.