Evaluation of a Peer Led Chronic Pain Self-Management Program in a Rural Population

Abstract

Background: The Chronic Pain Self-Management Program is an evidence-based intervention that has been shown to be efficacious in reducing symptoms of chronic pain. However, there is a paucity of research examining CPSMP in a predominantly rural population. The purpose was to evaluate patient-reported outcomes of in-person peer-led CPSMP workshops offered in a rural region in 2018 and 2019. Methods: Participants were surveyed at baseline and 6 months post-workshop. Descriptive statistics were used to describe characteristics of CPSMP completers. Paired t-tests were used to analyze change in depression score (PHQ-8), disability (modified Roland-Morris Disability Questionnaire), self-efficacy, and patient activation (PAM-10). Analysis of variance was used to detect differences over time by age group, education, insurance type, self-rated health, and comorbidities. Results: Among the 327 adults who enrolled in a workshop, 73.1% completed. Of completers, 74.9% were female, average age was 65. Significant improvements were observed in pain disability ( P = .0008), patient activation ( P = .0362), depression ( P < .0001), and self-efficacy ( P < .0001), at 6 weeks; and pain disability ( P = .0030), depression ( P = .0015), and self-efficacy ( P = .0064) at 6 months post-program. Individuals who rated their health as fair/poor at baseline reported greater improvements in depression scores than individuals who rated their health as good or better ( P < .0002). There were also distinct patterns of change in pain disability among the different age groups. No other differences between groups were noted. Conclusions: The CPSMP appears to improve pain self-efficacy, disability, and depression regardless of age, gender, insurance status, education, or comorbidities. Healthcare and community organizations should consider investing in and offering chronic pain workshops in rural areas in order to promote health and wellness.

Enrollment and Completion Characteristics for Novel Remote Delivery Modes of the Self-management Programs During the COVID-19 Pandemic: Exploratory Analysis

“…While a nationwide evaluation of the in-person CDSME workshops did not examine differences in education between completers and noncompleters, a Canadian study by McGowan found that education level was not a significant factor for completing in-person self-management workshops [ 13 ]. Our in-person workshop findings also indicated no significant difference in education level between completers and noncompleters [ 39 , 40 ].…”

Remote delivery of self-management education workshops for adults with chronic pain, 2020–2021

“…The mean pre-post changes in participant reported outcomes were similar to those observed for participants in the in-person workshops offered in the same region prior to 2020. 10 In a study of remote delivery of CPSMP using mailed toolkit with phone support from July-December 2020, Sheth et al found significant improvements in depression (PHQ-8), pain (visual analogue scale) and chronic disease self-efficacy at 6 weeks. 9 Mean changes for comparable measures (PHQ-8 and pain) were larger than what we observed (mean difference for PHQ-8 was −1.42 and pain was −5.94 compared with −1.03 and −0.61, respectively).…”

“…In-person completion rates were 73% in the studied region prior to the pandemic. 10 This finding could be attributed to secular trends, such as the pandemic, as well as the limited availability of low-latency, high-speed internet in parts of our region that makes staying connected to a 2½-hour long videoconference session difficult. But, it may also be related to the imperfect transferability of a program designed for in-person to a videoconference platform.…”

“…8,9 The purpose of this study was to evaluate pre-post changes in pain symptoms, pain disability, patient activation, pain self-efficacy and depression among rural adults experiencing chronic pain who completed a remotely delivered CPSMP or CDSMP workshop during the COVID-19 pandemic. Based on findings from the original in-person workshops, 10 we hypothesized that these measures would improve significantly following participation in a remotely delivered program. A second aim was to compare characteristics of workshop participants by delivery mode.…”

Chronische Schmerzen im Alter – psychologische Aspekte und ihre therapeutischen Konsequenzen*

“…kann das Schmerzselbstmanagement bedeutsam verbessern. Die Teilnehmenden (N = 327), die mehrheitlich über 65 Jahre alt waren, wiesen auch sechs Monate nach Programmende noch eine Verbesserung der schmerzbezogenen Selbstwirksamkeit, der schmerzbedingten Beeinträchtigung und der Depressivität auf, und zwar unabhängig vom Alter [45]. Dabei muss berücksichtigt werden, dass die Teilnehmer gesundheitlich eher gering beeinträchtigt waren: So stuften 57 % ihre gesundheitliche Verfassung als "gut" oder besser ein.…”