Chronic pain is reported by 20%-50% of patients seen in primary care and is a condition with which we are all too familiar. Chronic pain patients suffer while consuming tremendous amounts of health care resources. Long-term narcotics, regrettably, became a fact of life for many.
Clinical frustration, fatigue, and burnout with chronic pain management are frequently compounded by a dearth of proven, effective self-management strategies. Self-help may be on the way.
Linda S. Ruehlman and colleagues conducted a randomized controlled clinical trial evaluating the efficacy of a self-paced, interactive online chronic pain management program. In this study, 305 participants with chronic pain were randomized to a self-help online program for approximately 6 weeks or a wait-list control condition. Subjects were eligible for enrollment if they were at least 18 years old, had chronic pain for 6 months or longer, and had Internet access. Subjects were recruited online from pain-related websites.
The online program consisted of proven-effective, evidence-based psychosocial interventions for chronic pain. The program focused on cognition, behavior, social, and emotional regulation. Participants developed a customized learning plan, explored content of four modules with didactic and interactive components, practiced offline exercise and relaxation activities, tracked functional progress (pain management, mood, activity level), and engaged in social networking. Subjects in the wait-list control group received full access to the program at the end of the study.
This online pain program was associated with significant decreases in pain severity, pain-related interference and emotional burden, perceived disability, catastrophizing, and pain-induced fear. The program also significantly decreased depression, anxiety, and stress.
We need tools that complement the clinical resources that we expend managing patients with chronic pain. The tool used in this study is currently available online. According to recent statistics, 87% of individuals aged 30-49 years and 74% of those aged 50-64 years in the U.S. use the Internet. The likelihood is high, therefore, that our most our patients with chronic pain will have access to it. Our job is to motivate them to engage.
Dr. Ebbert is professor of medicine and a primary care clinician at the Mayo Clinic in Rochester, Minn. He reported having no conflicts of interest with the online pain program described in this article. The opinions expressed are solely those of the author. Contact him at ebbert.jon@mayo.edu.