Online Program Empowers Patients with Chronic Pain

An 8-week online intervention targeting cognitive, emotional, behavioral, and social pain determinants appears to improve pain intensity, pain interference, and pain self-efficacy among participants.

An 8-week online intervention targeting cognitive, emotional, behavioral, and social pain determinants appears to improve pain intensity, pain interference, and pain self-efficacy among participants. Washington State University investigators found that patients randomized to the intervention, dubbed the “Chronic Pain Management Program,” were able to manage their pain and reduce their reliance on opioids through education on non-medical alternatives like physical activity, positive thinking, and dealing with emotions.

For the study, published in the August 2015 issue of Pain Management Nursing, Marian Wilson, PhD, MPH, RN-BC, assistant professor in the College of Nursing, and colleagues evaluated program efficacy and engagement for 92 patients with a diagnosis of chronic non-cancer pain who had a current opioid prescription.

Study participants were recruited from primary care practices and Internet sites and then randomly assigned to receive access to the intervention immediately or after an 8-week delay. At week 8, patients in the immediate access group had significantly greater improvements on pain self-efficacy and opioid misuse measures than those in the 8-week delay group.

“With negative emotions, you often have that physical response of tension,” said Wilson. “So we really want people with pain to learn they have control and mastery over some of those physical symptoms. Meditation and relaxation can help with that.”

Wilson noted that such techniques are difficult for patients to obtain in standard care settings, despite the ability of these techniques to increase confidence in managing pain. She added that several studies have shown that this confidence, or self-efficacy, is associated with higher quality of life and ability to return to work and greater levels of activity.

“Maybe that pain is never going to go away but you can divert your attention from it,” said Wilson. “You can focus on more positive things and you can absolutely get that thought on a back burner rather than fixating on it.”

Wilson and colleagues also found that 80% of online program participants displayed progress toward goals to reduce or eliminate paint or other unspecified medications, compared with a rate of about 50% for those assigned to the 8-week delay group. “Unique to our study was the discovery that more appropriate use of opioid medicines could be an unintended consequence of participation,” she said.

And that unintended consequence could go a long way toward avoiding the more than 15,000 opioid overdose-related deaths in the United States each year, 60% of which occur in patients with legitimate prescriptions.

“For many patients, more and more evidence is coming out that if we can get them off the opiates, or reduce their use and help them become more active, they'll actually feel better,” said Wilson. “Plus they won't be at risk for death from opioid overdose, which they're at risk for now because you often have to keep increasing the opioid dose to get the same pain relief.”