Empowering Patients with Persistent Pain Using an Internet-based Self-management Program

Abstract

New strategies are needed to improve care for patients with persistent pain. Biopsychosocial models for pain treatments are effective, yet remain inaccessible, particularly for patients with limited resources and from communities lacking specialized pain services. Prior research suggests that self-management programs can improve pain experiences. Less is known about how programs can be accessed using computer technology and whether patients who receive opioids can engage in them and find benefit. The purpose of this randomized controlled study was to investigate an 8-week Internet-based self-management program among patients with persistent pain who are prescribed opioid medication. The program, Goalistics Chronic Pain Management Program (CPMP), consists of online self-directed learning modules that focus on cognitive, behavioral, social, and emotional regulation (Ruehlman, Karoly, & Enders, 2011). The intervention was tested within the conceptual framework provided by Ryan and Sawin's Individual and Family Self-Management Theory (2009). Patients were recruited from primary care clinics and Internet sites, then randomly assigned to treatment (n = 45) or treatment as usual wait list group (n = 47). The primary aim was to evaluate the effect of the program on self-reported pain intensity and pain interference using the Brief Pain Inventory. Secondary outcomes were measured with the Patient Health Questionnaire (PHQ-8) for depressive symptoms, the Current Opioid Misuse Measure (COMM), the Pain Self-efficacy Questionnaire (PSEQ), and the Patient Global Impression of Change (PGIC). Included were participant reports of nonpharmacologic therapies incorporated and program satisfaction. Significant improvements were observed for pain self-efficacy and current opioid misuse in the treatment group using data collected from bi-weekly online surveys. Number Needed to Treat analysis found a 2 point decrease in pain intensity achieved by 18% of treatment group members compared to 6% of those in the comparison group. Therefore, 8 people would need to be treated with the CPMP to achieve clinically meaningful improvement in pain intensity within 8 weeks. Depressive symptoms significantly improved for all participants. Program satisfaction was high and most comments suggested increased guidance and instruction to improve future participation. Engagement level varied and was positively associated with improvements in pain intensity, pain interference, and pain self-efficacy.