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Mehlsen M, Hegaard L, Ornbol E, et al. The effect of a lay-led, group-based self-management program for patients with chronic pain: a randomized controlled trial of the Danish version of the Chronic Pain Self-Management Programme. Pain. 2017 Aug;158(8):1437-1445. doi: 10.1097/j.pain.0000000000000931.
Discipline Area Score
Psychologist 6 / 7
Physician 5 / 7
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  Chronic Pain
Abstract

The Stanford Chronic Pain Self-Management Programme (CPSMP) consists of 6 2½-hour weekly workshops focusing on how to manage pain in daily life. The workshops are facilitated by 2 workshop leaders of whom at least 1 must suffer from a long-term pain condition. The program is highly structured and manualized. Only few controlled trials testing the effect of CPSMP exist. Enrolled in the study were 424 adults from 19 Danish municipalities, (72% women; age: 25-93 years) with pain of any etiology and great variation in pain history (0-50 yrs). Of these, 216 were randomized to a lay-led version of the CPSMP. The primary outcome was pain-related disability. Secondary outcomes were pain, pain catastrophizing, self-efficacy, emotional distress, physical symptoms, and illness worry. Outcomes were measured before randomization, immediately after the CPSMP (response rate: 94%), and at 3-month follow-up (response rate: 92%). National register data on health expenditure were obtained to examine effects on health care use. ClinicalTrials.gov Identifier: NCT01306747. The CPSMP had no effect on the primary outcome pain-related disability or on health expenditure during intervention and follow-up period. Small positive effects on emotional distress and illness worry 3 months after CPSMP were observed. Lay-led CPSMP is not recommended as treatment for chronic pain-related disability. This heterogeneous group of patients with pain did not benefit from the CPSMP except for a small, but clinically insignificant improvement in psychological well-being.

Comments from MORE raters

Physician rater

Chronic pain management is complex, resource-intensive and frustrating. This research indicates that structured supportive education and self-management has little, if any, effect on improving outcomes for such patients.

Physician rater

Important subject. Well done study. Negative results are also important to publish.

Physician rater

It is important to revalidate commonly used therapeutic tools. It is not about downgrading a treatment modality, but rather redefining its areas of strength to be more selectively applied for better patient outcomes.

Physician rater

This evaluates the effect of a very specific intervention of which I have no experience - sadly, very little effect was observed.

Psychologist rater

This is an important and ambitious trial. The findings match my clinical experience in leading group-based psychological interventions for a wide variety of medical conditions. I now believe involving lay persons is fundamental to success, however treatment quality and fidelity needs be led by a health care professional skilled in aspects of group therapy (blending process with content).
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