Among persons with High Impact Chronic Pain (HICP), we assessed the impact of cognitive behaviorally-based self-management interventions on sustained HICP and on favorable chronic pain outcomes (mild or discontinued chronic pain). Adults with HICP (N=2331) were randomly assigned to: a remote 8-session Health Coach intervention; an 8-session self-completed on-line painTRAINER program; or to Usual Care Plus educational materials. Participants were re-assessed at 3, 6 and 12 months. At 3 months, favorable chronic pain outcomes were somewhat more common among intervention participants than controls, but rates of sustained HICP were similar across all three study groups. At 6 and 12 months, over 40% of intervention participants reported favorable chronic pain outcomes compared to about 30% of Usual Care Plus participants. At 6 and 12 months, 36-42% of intervention participants had sustained HICP, compared to 50-52% of Usual Care Plus participants. At 3 months, relative risk confidence intervals for sustained HICP for the two intervention groups (compared to Usual Care Plus) included 1.0 indicating differences within chance expectation. At 3 months, relative risks of favorable chronic pain outcomes were 1.43 for painTRAINER and 1.39 for Health Coach interventions, compared to Usual Care Plus. At 6 and 12 months, relative risks for sustained HICP were about 0.8 for painTRAINER and Health Coach participants (compared to Usual Care Plus), while relative risks of a favorable chronic pain outcome were 1.24-1.44. Among participants with HICP, self-management interventions modestly reduced rates of sustained HICP and increased favorable chronic pain outcomes.
| Discipline Area | Score |
|---|---|
| Psychologist |  |
| Physician |  |
Physician rater
As a geriatric psychiatrist, I commonly see patients with chronic pain that negatively interacts with their psychiatric conditions. This study reports minimal to modest benefits from self-management interventions on chronic pain outcomes. The effects are likely too small for me to recommend an intervention like this.
Psychologist rater
Convincing data that provide evidence that generally available psychological interventions can have modest benefits in patients with debilitating chronic pain. Unfortunately, the data also confirm that these conditions are very difficult to ameliorate significantly.
Psychologist rater
It is encouraging that CBT-CP interventions delivered via telehealth or self-guided online modules can improve pain, functioning, and quality of life, and may increase access to evidence-based care. However, the observed effects were, once again, modest. This raises the question of whether psychological treatments for chronic pain require greater individualization through functional analysis and case formulation. Pharmacological and physical treatments are generally not delivered through standardized, self-administered online programs because one size does not fit all and each patient must be carefully assessed before treatment is prescribed. By contrast, psychological treatments in clinical trials are often delivered by non-specialists and follow homogeneous protocols that may not reflect real-world clinical complexity or the particularities of each case. Results are encouraging, but I guess that unless these issues are addressed, treatment effects are likely to remain modest.
, McMaster University