Online program reduces chronic pain in patients on long-term opioid therapy
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Key takeaways:
- More than half of patients in the program reduced opioid use by at least 15% in 6 months.
- The program’s affordability and convenience address common barriers to chronic pain management.
Patients with chronic pain who received long-term opioid therapy had reductions in both pain and daily opioid doses following the use of an online pain management program, a recent study found.
Marian Wilson, PhD, MPH, RN PMGT-BC, an associate professor at the College of Nursing at Washington State University, and colleagues wrote that previous research has supported self-management programs to improve pain intensity and reduce disability, “with similar outcomes obtained using face-to-face or internet-based programs.”
“Internet-based programs could, potentially, allow for increased ability to standardize and replicate effective programs, making them accessible and affordable to people with chronic pain,” they wrote in Pain.
Citing a lack of data on how well these programs reduce opioid use, the researchers performed a randomized clinical trial that compared the “e-health” Goalistics Chronic Pain Management Program with treatment as usual (TAU).
The researchers randomly assigned 402 participants (69.4% women) from 38 primary care and pain clinics at two academic health systems to receive a 4-month subscription to the e-health intervention (n = 200) or TAU (n = 202). The participants had a mean age of 57 years and at least one chronic pain-related diagnosis.
The e-health program provided pain tracking tools, cognitive therapy, information on exercise and relationship advice, as well as educational materials about opioid use and risks. Wilson said in a press release that the program offers content that is similar to services that are provided by psychologists who specialize in pain. They chose the Goalistics Chronic Pain Management Program since it is widely available to patients.
Of the 196 e-health program participants who completed the trial, 53.6% achieved a 15% or greater reduction in daily morphine equivalent dose (MED) at 6 months, compared with 42.3% of the TAU participants (OR = 1.6; 95% CI, 1.1-2.3), according to Wilson and colleagues.
Meanwhile, of 166 e-health participants with available information, 14.5% had a two point or greater decrease in pain intensity, compared with 6.8% of 192 TAU participants (OR = 2.3; 95% CI, 1.1-4.7).
The researchers also reported improvements in secondary pain-related outcomes among e-health participants vs. their TAU counterparts, which included pain knowledge, self-efficacy and coping.
Wilson and colleagues wrote that the study adds to existing literature by “capturing MED from clinical records vs self-report, which increases confidence that the program can be beneficial in reducing opioid use.”
In addition to its efficacy, the researchers noted that the program, which costs an estimated $120 over 4 months, “could be done from home, and could be completed at a pace and schedule suited to an individual's preferences.”
They added that with 34% of study participants being disabled, “an online e-health option could help reduce pain care disparities for people who have disabilities or are homebound.”
Regarding the program’s implementation into clinical practice, Wilson and colleagues wrote that its facilitation by professionals or community health workers with experience in behavioral health and pain management could improve engagement and outcomes.
“Research on optimal implementation approaches for providing access to, and encouraging use of, pain education and self-management tools seems warranted,” they concluded. “Augmenting usual care with pain self-management content may aid in opioid dose reduction, even when opioid use is not explicitly targeted.”
References:
- Chronic pain management program. https://www.mood.goalistics.com/copy-of-home. Accessed April 4, 2023.
- E-health reduces patient pain, opioids in clinical study. https://www.eurekalert.org/news-releases/984717. Published April 3, 2023. Accessed April 3, 2023.
- Wilson M, et al. Pain. 2023;doi:10.1097/j.pain.0000000000002785.