Fidelity of Peer Supported Self-Management of Chronic Pain (Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms—ECLIPSE)

Background: ECLIPSE (Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms) is a randomized controlled trial testing peer-supported chronic pain self-management. Veterans are paired with a peer coach (also with chronic pain) for 6 months. Peer coaches (PCs) and veterans meet or talk by phone 2x/month about pain self-management strategies, and veterans receive motivation and encouragement from their PC. To determine if the intervention was delivered as intended, fidelity was assessed at the end of the intervention period. Fidelity assessment is vital to help understand reasons for an intervention’s success or failure. Methods: Intervention veterans were asked about the intervention’s delivery during their 6-month assessment, after intervention completion. Presence or absence of four “essential elements” of the intervention were evaluated, as well as meeting frequency. Results: Scoring of veteran assessments revealed 74% of PC’s discussed self-management strategies and 69% of veterans felt motivated by their PC. Only 52% discussed how to adjust strategies and 34% discussed goal-setting. PC-veteran meeting frequency varied: 16% met weekly, 21% met twice a month, 16% met once a month, and 46% met less than once a month. 47% of PC’s had greater than 75% fidelity (i.e., the presence of at least 3 of 4 elements described above). Conclusion and Potential Impact: About half of PC’s delivered the intervention with at least 75% fidelity. Fidelity was greater for discussing self-management strategies and motivating veterans. Results suggest that peer-supported self-management can be delivered with fidelity but PCs may need additional training to do so consistently.

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Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial

Journal of General Internal Medicine ◽

10.1007/s11606-020-06007-6 ◽

2020 ◽

Vol 35 (12) ◽

pp. 3525-3533

Author(s):

Marianne S. Matthias ◽

Matthew J. Bair ◽

Susan Ofner ◽

Michele Heisler ◽

Marina Kukla ◽

...

Keyword(s):

Chronic Pain ◽

Peer Support ◽

Self Management ◽

Pain Symptoms ◽

Peer Coach

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An observational study of pain self-management strategies and outcomes: does type of pain, age, or gender, matter?

Scandinavian Journal of Pain ◽

10.1515/sjpain-2018-0070 ◽

2018 ◽

Vol 18 (4) ◽

pp. 645-656 ◽

Cited By ~ 3

Author(s):

Marion K. Slack ◽

Ramon Chavez ◽

Daniel Trinh ◽

Daniel Vergel de Dios ◽

Jeannie Lee

Keyword(s):

Chronic Pain ◽

Acute Pain ◽

Management Strategies ◽

Demographic Characteristics ◽

Self Management ◽

Treatment Level ◽

Pain Group ◽

Age And Gender ◽

Pain Characteristics ◽

And Gender

AbstractBackground and aimsAcute pain is differentiated from chronic pain by its sudden onset and short duration; in contrast, chronic pain is characterized by a duration of at least several months, typically considered longer than normal healing time. Despite differences in definition, there is little information on how types of self-management strategies or outcomes differ when pain is chronic rather than acute. Additionally, age and gender are thought to be related to types of strategies used and outcomes. However, strategies used and outcomes can be influenced by level of education, socioeconomic status, occupation, and access to the health care system, which can confound associations to type of pain, age or gender. The purpose of this study was to examine the association of strategies used for pain self-management and outcomes with type of pain, acute or chronic, age, or gender in a socioeconomically homogenous population, pharmacists.MethodsPharmacists with acute or chronic pain and a valid email completed an on-line questionnaire on demographic characteristics, pain characteristics, pharmacological and non-pharmacological strategies for managing pain, and outcomes (e.g. pain intensity). Univariate analysis was conducted by stratifying on type of pain (acute or chronic), then stratifying on gender (men vs. women) and age (younger vs. older). Thea priorialpha level was 0.05.ResultsA total of 366 pharmacists completed the questionnaire, 212 with acute pain (average age=44±12.1; 36% men) and 154 with chronic pain (average age=53±14.0; 48% men). The chronic pain group reported substantially higher levels of pain before treatment, level of post-treatment pain, level of pain at which sleep was possible, and goal pain levels (effect sizes [ES’s]=0.37–0.61). The chronic pain group were substantially more likely to use prescription non-steroidal anti-inflammatory medications (NSAIDS), opioids, and non-prescription pain relievers (ES’s=0.29–0.80), and non-medical strategies (ES’s=0.56–0.77). Participants with chronic pain also were less confident (ES=0.54) and less satisfied (ES=0.52). In contrast, there were no differences within either the acute or chronic pain groups related to gender and outcomes. In the acute pain group, there also were no gender differences related to management strategies. However, younger age in the acute pain group was associated with use of herbal remedies and use of rest. Within the chronic pain group, men were more likely to use NSAIDS and women more likely to use hot/cold packs or massage while older participants were more likely to use massage. Variability in post-treatment level of pain and percent relief was high in all groups (coefficient of variation=25%–100%).ConclusionsThe differences between acute and chronic pain were substantial and included differences in demographic characteristics, pain characteristics, management strategies used, and outcomes. In contrast, few associations between age and gender with either management strategies or outcomes were identified, although the variability was high.ImplicationsWhen managing or researching pain management, acute pain should be differentiated from chronic pain. Because of the substantial variability within the gender and age groups, an individual approach to pain management irrespective of age and gender may be most useful.

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Multimodal, Integrative Therapies for the Self-Management of Chronic Pain Symptoms

Pain Medicine ◽

10.1111/pme.12408 ◽

2014 ◽

Vol 15 (S1) ◽

pp. S76-S85 ◽

Cited By ~ 26

Author(s):

Courtney Lee ◽

Cindy Crawford ◽

Steven Swann ◽

Keyword(s):

Chronic Pain ◽

The Self ◽

Self Management ◽

Pain Symptoms ◽

Integrative Therapies

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Feasibility of a Hybrid Web-Based and In-Person Self-management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma (iPACT-E-Trauma): A Pilot Randomized Controlled Trial

Pain Medicine ◽

10.1093/pm/pnz008 ◽

2019 ◽

Vol 20 (10) ◽

pp. 2018-2032 ◽

Cited By ~ 2

Author(s):

M Bérubé ◽

C Gélinas ◽

N Feeley ◽

G Martorella ◽

J Côté ◽

...

Keyword(s):

Chronic Pain ◽

Pain Catastrophizing ◽

Controlled Trial ◽

Self Management ◽

Anxiety And Depression ◽

Management Intervention ◽

Randomized Controlled ◽

Extremity Trauma ◽

Experimental Group ◽

Pilot Randomized Controlled Trial

Abstract Objective 1) To assess the feasibility of research methods to test a self-management intervention aimed at preventing acute to chronic pain transition in patients with major lower extremity trauma (iPACT-E-Trauma) and 2) to evaluate its potential effects at three and six months postinjury. Design A pilot randomized controlled trial (RCT) with two parallel groups. Setting A supraregional level 1 trauma center. Methods Fifty-six adult patients were randomized. Participants received the intervention or an educational pamphlet. Several parameters were evaluated to determine the feasibility of the research methods. The potential efficacy of iPACT-E-Trauma was evaluated with measures of pain intensity and pain interference with activities. Results More than 80% of eligible patients agreed to participate, and an attrition rate of ≤18% was found. Less than 40% of screened patients were eligible, and obtaining baseline data took 48 hours postadmission on average. Mean scores of mild pain intensity and pain interference with daily activities (<4/10) on average were obtained in both groups at three and six months postinjury. Between 20% and 30% of participants reported moderate to high mean scores (≥4/10) on these outcomes at the two follow-up time measures. The experimental group perceived greater considerable improvement in pain (60% in the experimental group vs 46% in the control group) at three months postinjury. Low mean scores of pain catastrophizing (Pain Catastrophizing Scale score < 30) and anxiety and depression (Hospital Anxiety and Depression Scale scores ≤ 10) were obtained through the end of the study. Conclusions Some challenges that need to be addressed in a future RCT include the small proportion of screened patients who were eligible and the selection of appropriate tools to measure the development of chronic pain. Studies will need to be conducted with patients presenting more serious injuries and psychological vulnerability or using a stepped screening approach.

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