Rapid design and implementation of a virtual pain management programme due to COVID-19: a quality improvement initiative

Background This paper describes the development of an eight-week Compassion Focused Therapy for Pain Management (CFT-PM) group. This group was specifically designed for ‘strivers’ a sub-group of people with persistent pain who tend to engage in over-activity and resist making reasonable adjustments to their activity levels to accommodate their persistent pain. ‘Strivers’ tend to cope by ignoring their pain and pushing on through, in the shorter term leading to ‘boom and bust’ activity-related exacerbations of their pain. They also risk the development of additional persistent fatigue and burnout in the longer term. Method 117 people completed the CFT-PM group; The group was delivered in person ( n = 84) but in online format from July 2020 ( n = 33). 162 people started the CFT-PM group but 45 dropped-out (27.43%). Results There was a significant effect for time across all measures: significant improvement was found for depression, self-compassion, pain-related disability, pain-related anxiety and pain self-efficacy. Pain numeric rating scores were approaching significance. There was a significant main effect of diagnosis; post-hoc t-test analysis found significant improvement for all diagnoses on all measures with the exception of spinal. There was also a significant interaction between time and format: post-hoc t-test analysis found greater improvement for virtual format on self-compassion and pain-related anxiety. Discussion Findings suggests that CFT-PM may be a clinically effective group intervention with virtual format showing superior improvement. This approach might be less suitable for certain diagnoses; the spinal group may benefit more from traditional CBT-based PMPs. Limitations include the lack of random selection or allocation to treatment group. Future studies should adopt an experimental design to be able to draw firm conclusions regarding causation and efficacy. Despite these limitations, present findings suggest that CFT-PM may be an effective group intervention worthy of further investigation and clinical application.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Compassion focused therapy for pain management: ‘3 systems approach’ to understanding why striving and self-criticism are key psychological barriers to regulating activity and improving self-care for people living with persistent pain

Malpus

Nazar

Smith

et al. 2022

“…This evaluation explored the acceptability of a remotely delivered pain management programme that was designed and implemented due to the COVID-19 pandemic. 9 Overall, this evaluation found that there is a spectrum of acceptability regarding the vPMP. Although the objective of this study was not to determine the number of patients that would prefer a remote or an in-person programme, some patients indicated that they were completely satisfied with the vPMP, whereas most patients inferred that they would not choose a vPMP over an in-person programme.…”

Section: Discussionmentioning

confidence: 86%

The patient acceptability of a remotely delivered pain management programme for people with persistent musculoskeletal pain: A qualitative evaluation

Booth

Zala

Mitchell

et al. 2022

Self Cite

Introduction Remotely delivered pain management programmes have been offered in place of in-person programmes by many chronic pain services since the onset of the COVID-19 pandemic. There is a lack of evidence regarding the acceptability of these programmes. In this evaluation, we have explored patients’ acceptability of a remotely delivered pain management programme for patients with persistent musculoskeletal pain. Methods Qualitative data were collected using focus groups with participants who had previously attended the remote pain management programme. Data were analysed using abductive analysis. Results Three focus groups were conducted with a total of 13 participants. The programmme was either entirely acceptable, had some acceptable components or was not acceptable to patients. Factors leading to the programme being acceptable include learning to manage pain from home, receiving high quality care from home, enhancing the potential of rehabilitation using technology, enabling attendance on a pain management programme from home, overcoming social distancing requirements of COVID-19 using technology, and virtual peer support. Factors leading to the programme not being acceptable include having an inappropriate home environment for virtual therapy, communication challenges with virtual therapy, technological issues and concerns regarding the quality of care. Conclusions There is a spectrum of acceptability with respect to the remote programme. The factors that influence this are dynamic, individual and situational. Hybrid programmes have the potential to enhance access to pain management programmes and improve patient experience and programme outcomes in the future.

“…Considerable effort went into rapidly developing alternatives and soon virtual options for assessment and treatment delivery were trialled. 13 , 14 Within this context, our service redeveloped a number of previous in-person PMPs for virtual delivery, which included high and low intensity virtual PMPs and a virtual neuromodulation PMP, among other options. These virtual programmes were designed to meet the needs of patients previously recommended our in-person residential, outpatient and neuromodulation PMPs, with the more intensive PMPs designed to support people with more severe or complex pain-related disability and/or distress than the lower intensity PMP.…”

Section: Introductionmentioning

confidence: 99%

“… 18 Although functionalities such as ‘breakout rooms’ can enable treatment participants to share their thoughts and feelings, this may disrupt the natural flow of communication and engagement that happens during in-person treatments. Additionally, participants can experience screen fatigue, 13 limiting the length and number of virtual sessions.…”

Section: Introductionmentioning

confidence: 99%

An updated audit of the patient selection process for pain management programmes in a speciality care service before and during the COVID-19 pandemic

Buscemi

Chicken

Mahy

et al. 2022

Background The provision of pain management programmes (PMPs) changed substantially in response to the COVID-19 pandemic with virtual delivery implemented in many services. Little is known about patient selection processes for virtual PMPs and how this might differ from in-person programmes. The aim of this audit was to document the patient selection process for PMPs at a speciality pain service prior to and during the pandemic. Methods This retrospective audit used data from consecutive patients attending a multidisciplinary assessment to determine the suitability of a PMP. Anonymized data were extracted from assessment letters and hospital records in the months prior to the pandemic (n =168) and during the start of the pandemic once the service began delivering virtual PMPs (n =171). Results For the standard pain management pathway, most patients were offered a PMP option within the service before and during the pandemic, although a greater proportion of patients were offered treatment during the pandemic. For the neuromodulation pathway, most patients were offered a pre-neuromodulation PMP option, and this was similar before and during the pandemic. Psychosocial complexities and unwillingness to engage in a pain management approach that does not principally focus on pain reduction were the most common reasons that patients were not offered a programme. Discussion This audit points to a pattern of more inclusive assessment outcomes within our service over time and particularly during the pandemic. Offering a range of in-person and virtual PMPs can meet a wider range of patient need. Research is needed to understand how to best assess and match patients with the breadth of treatment delivery formats now available.