Internet‐Based Pain Self‐Management for Veterans: Feasibility and Preliminary Efficacy of the Pain EASE Program

Higgins, Diana M.; Buta, Eugenia; Williams, David A.; Halat, Allison M; Heapy, Alicia; Krein, Sarah L.; Rajeevan, Haseena; Rosen, Marc I.; Kerns, Robert D.

doi:10.1111/papr.12861

Cited by 11 publications

(13 citation statements)

References 40 publications

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“…It is difficult to summarize findings into meaningful categories given the variety of eHealth-mediated self-management support interventions. Two studies reported good satisfaction, 33 , 34 3 studies reported good acceptability, 35–37 and 2 studies reported that participants with MSDs found the eHealth-mediated self-management support interventions to be beneficial. 38 , 39 …”

Section: Resultsmentioning

confidence: 99%

eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, “eHealth: It’s TIME”—A Scoping Review

et al. 2022

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Objective eHealth-mediated interventions have been proposed as one option to support self-management in those with musculoskeletal disorders (MSDs). This scoping review aimed to chart the evidence regarding eHealth modalities, musculoskeletal diagnosis, and outcomes of eHealth-mediated self-management support interventions in persons with MSDs and identify any gaps within the literature. Methods Six electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus and the Cochrane Database of Systematic Reviews), seven grey literature sources (eg, OpenGrey) and reference and citation lists of included studies were searched from database inception to July 2020. Published studies of adult participants with a MSD utilizing an eHealth intervention to support self-management were included. Studies were limited to those published in English. Two reviewers independently screened all studies. Data was extracted by 1 reviewer and reviewed by another reviewer. Results After screening 3377 titles and abstracts followed by 176 full-texts, 87 studies fulfilled the eligibility criteria. The majority were published in the last 5 years (n = 48; 55%), with almost one-third originating in the United States (n = 28; 32%). The most common eHealth modality type was internet-based (n = 22; 35%) with almost one-half (n = 41; 47%) of the included studies involving participants with widespread musculoskeletal symptoms. The most commonly reported outcomes related to body functions (ie, pain intensity) (n = 67; 45%), closely followed by activities and participation (ie, function) (n = 65; 44%) with environmental factors (ie, healthcare utilization) the least commonly reported (n = 17; 20%). Conclusions There is considerable variation within the eHealth-mediated self-management support intervention literature. Research is needed on the role of eHealth-mediated self-management support interventions across a broad range of MSDs to guide clinical practice. Impact This scoping review has identified gaps in the literature relating to specific eHealth modalities, musculoskeletal diagnoses and healthcare utilization data which should guide future research.

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Section: Resultsmentioning

confidence: 99%

eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, “eHealth: It’s TIME”—A Scoping Review

et al. 2022

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“…The majority of the intervention was delivered in a group-format, making it potentially more affordable than individually delivered CBT interventions. Recent CBT-based electronically delivered interventions 40,41 may provide even greater value-for-money, given the potentially lower interventionrelated costs of such approaches. We found few multidisciplinary pain management studies that reported the cost per additional responder as an outcome.…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluation

et al. 2022

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Background: Chronic pain is prevalent and costly; cost-effective nonpharmacological approaches that reduce pain and improve patient functioning are needed.Objective: Report the incremental cost-effectiveness ratio (ICER), compared with usual care, of cognitive behavioral therapy aimed at improving functioning and pain among patients with chronic pain on long-term opioid treatment.Design: Economic evaluation conducted alongside a pragmatic cluster randomized trial.Subjects: Adults with chronic pain on long-term opioid treatment (N = 814).Intervention: A cognitive behavioral therapy intervention teaching pain self-management skills in 12 weekly, 90-minute groups delivered by an interdisciplinary team (behaviorists, nurses) with additional support from physical therapists, and pharmacists.Outcome Measures: Cost per quality adjusted life year (QALY) gained, and cost per additional responder ( ≥ 30% improvement on standard scale assessment of Pain, Enjoyment, General Activity, and Sleep). Costs were estimated as-delivered, and replication.Results: Per patient intervention replication costs were $2145 ($2574 as-delivered). Those costs were completely offset by lower medical care costs; inclusive of the intervention, total medical care over follow-up was $1841 lower for intervention patients. Intervention group patients also had greater QALY and responder gains than did controls. Supplemental analyses using pain-related medical care costs revealed ICERs of $35,000, and $53,000 per QALY (for replication, and as-delivered intervention costs, respectively); the ICER when excluding patients with outlier follow-up costs was $106,000.Limitations: Limited to 1-year follow-up; identification of painrelated utilization potentially incomplete. Conclusion:The intervention was the optimal choice at commonly accepted levels of willingness-to-pay for QALY gains; this finding was robust to sensitivity analyses.

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“…Internet-based CBT programs have been evaluated in other populations with chronic pain [ 71 , 72 ] and have shown promising results. However, these prior programs are largely self-directed, requiring minimal, if any, clinician involvement.…”

Section: Discussionmentioning

confidence: 99%

Development of an internet-delivered cognitive behavioral therapy program for use in combination with exercise therapy and education by patients at increased risk of chronic pain following total knee arthroplasty

Rognsvåg

Lindberg

Lerdal

et al. 2021

BMC Health Serv Res

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Background Approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA). Due to the growing number of TKA procedures, this will affect an increasing number of people worldwide. Catastrophic thinking, dysfunctional illness perception, poor mental health, anxiety and depression characterize these non-improvers, and indicate that these patients may need individualized treatment using a treatment approach based on the bio-psycho-social health model. The present study developed an internet-delivered cognitive behavioral therapy (iCBT) program to be combined with exercise therapy and education for patients with knee osteoarthritis (OA) at increased risk of chronic pain after TKA. Methods The development process followed the first two phases of the UK Medical Research Council framework for complex interventions. In the development phase, the first prototype of the iCBT program was developed based on literature review, established iCBT programs and multidisciplinary workshops. The feasibility phase consisted of testing the program, interviewing users, condensing the program, and tailoring it to the patient group. A physiotherapist manual was developed and adapted to physiotherapists who will serve as mentors. Results The development process resulted in an iCBT program consisting of 10 modules with educational texts, videos and exercises related to relevant topics such as goalsetting, stress and pain, lifestyle, automatic thoughts, mindfulness, selective attention, worry and rumination. A physiotherapist manual was developed to guide the physiotherapists in supporting the patients through the program and to optimize adherence to the program. Conclusions The iCBT program is tailored to patients at risk of chronic pain following TKA, and may be useful as a supplement to surgery and/or exercise therapy. A multicentre RCT will evaluate the iCBT program in combination with an exercise therapy and education program. This novel intervention may be a valuable contribution to the treatment of OA patients at risk of chronic pain after TKA. Trial registration The RCT is pre-registered at ClinicalTrials.gov: NCT03771430 11/12/2018.

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Internet‐Based Pain Self‐Management for Veterans: Feasibility and Preliminary Efficacy of the Pain EASE Program

Cited by 11 publications

References 40 publications

eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, “eHealth: It’s TIME”—A Scoping Review

eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, “eHealth: It’s TIME”—A Scoping Review

Economic Evaluation

Development of an internet-delivered cognitive behavioral therapy program for use in combination with exercise therapy and education by patients at increased risk of chronic pain following total knee arthroplasty

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