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Chronic pain self-management programs improve physical function

Group and individual self-management training for chronic pain with a health educator helped to significantly improve physical and cognitive function among low-income patients, according to a study published in the Journal of General Internal Medicine.

“Although experts endorse nonpharmacologic interventions as first-line treatment for chronic pain management, low-income patients often lack access to these approaches,” Barbara J. Turner, MD, the James D. and Ona I. Dye Professor of Medicine at the University of Texas Health San Antonio, and colleagues wrote. “A practical chronic pain self-management program integrating components of a functional restoration program may offer a valuable resource for vulnerable populations.”

Turner and colleagues conducted a trial to investigate the effectiveness of two low-cost programs for providing pain management education and support to patients with limited access to resources. The researchers enrolled 111 low-income patients aged between 35 and 70 years who were taking opioids to manage chronic noncancer pain for more than 2 months.

They randomly assigned patients to either the clinic arm (n = 53) or the community arm (n = 58). In the clinic arm, patients attended monthly one-on-one meetings with a trained chronic pain health educator for 6 months. In the community arm, participants attended nine 1-hour group lectures with a trained health educator at a local library every 2 weeks for 3 months, then monthly for 3 months. The meetings for both arms offered the same information and demonstrations of physical therapy exercises.

The researchers measured physical and cognitive function at baseline and 3 months and 6 months. They used several assessments, including the Five Times Sit-to-Stand Test, 6-Min Walk test, Borg Perceived Effort Test, 50-ft Speed Walk, SF-12 Physical Component Summary, Patient-Specific Functional Scale and Symbol–Digit Modalities Test.

Intention-to-treat analyses revealed that participants in both arms completed the Five Times Sit-to-Stand Test faster after 6 months and also had higher scores on the Borg Perceived Effort Test, Patient-Specific Functional Scale and Symbol–Digit Modalities Test.

Only patients in the clinic arm showed improvements in the 6-Min Walk test and SF-12 Physical Component Summary. Scores on the 50-ft Speed Walk test did not change for either arm during the study.

The researchers reported five falls, which could be regarded as adverse events.

“The success of this program may lie in providing subjects with training on multiple self-management methods, since no single nonpharmacologic intervention for chronic pain has shown a consistently large effect,” Turner and colleagues concluded.

“Our easily replicable self-management program may represent a promising resource to help low-income patients with chronic pain adopt a more proactive lifestyle to manage this debilitating disease,” they added. – by Alaina Tedesco

Disclosures: The authors report no relevant financial disclosures.