Online Resource Beneficial for Underserved Pain Patients

Pauline Anderson

November 14, 2018

An interactive Web-based resource that offers self-care tools, meditation, yoga, and nutritional guidance and includes group medical visits reduces chronic pain in patients with little or no access to in-person therapies, new research shows.

Using conventional pharmacologic therapies, most patients report only modest or moderate pain relief at best. Patients of lower socioeconomic status (SES) may have difficulty accessing any pain therapies because of financial and logistical factors, Paula Gardiner, MD, associate professor, University of Massachusetts Medical School, and director, Medical Group Visit Program, told delegates attending the Academy of Integrative Pain Management (AIPM) Inaugural Global Pain Clinician Summit 2018.

The Our Whole Lives (OWL) pain management platform provides online materials for integrative medical group visits. Such materials include videos featuring clinician-led talks on pain control, stress, insomnia, obesity, depression, nutrition, and goal setting.

Patients are introduced to self-massage techniques, acupressure, and healthy cooking. They're encouraged to track their vital signs and health goals and to participate in a monitored discussion group with peers.

Each group includes 10 to 15 patients and two facilitators (typically a nurse practitioner, MD, or physician assistant who is a prescriber) as well as a cofacilitator, such as a community health worker. Groups discuss topics such as physical activity, lifestyle changes, mindfulness, and psychological problems.

Patients can access OWL using a computer or smartphone.

The OWL website is interactive. Patients can log the number of hours of yoga they perform at home and support one another online. There is also a "virtual" patient advocate.

For the study, investigators reached out to primary care providers in the Boston area for referrals and recruited patients from area community health centers.

The study included 43 adult patients (mean age, 50.4 years; 91% women; 37% black; 30% white). About 26% had a yearly household income of $10,000 or less.

For a period of at least 3 months, study participants self-reported chronic pain (extremity, joint, back, or neck) in which the average pain intensity for the previous week was greater than 4 on a 0 to 10 numerical rating scale.

Almost three quarters of the participants (74%) were taking medications; 44% were taking opioids, and 51% were taking a nonsteroidal anti-inflammatory drug (NSAID).

Pain Med Use Reduction

At study outset, participants were oriented to the OWL program. They were taught how to log onto the system, navigate through the various sessions, complete self-assessments, set goals, and interact on the community page.

Researchers used the Patient-Reported Outcomes Measurement Information System (PROMIS) to measure self-reported physical function, anxiety, depression, fatigue, sleep disturbance, and several pain measures, including self-efficacy (confidence in ability to successfully perform specific tasks or behaviors), impact, and intensity.

After a 9-week follow-up, 83% of the participants were taking medications. Opioid use had significantly decreased to 31%, and NSAIDS use had decreased to 44%.

Depression (P = .02), pain intensity (P = .003), and the pain impact score (P = .007) all significantly decreased. In addition, participants had significantly increased pain self-efficacy (P = .01), although the intervention had no impact on perceived stress.

A limitation of the study was that participants had to have access to the Internet.

Patients have expressed their appreciation of OWL group sessions, Gardiner told meeting delegates. Some reported that they felt less alone, had learned from other group members, and had gained a deeper perspective on their own illness after hearing stories from others suffering even more pain.

Exciting Research

Commenting on the study for Medscape Medical News, Clayton Jackson, MD, president, Academy of Integrative Pain Management, and clinical assistant professor of family medicine and psychiatry, University of Tennessee College of Medicine, Memphis, said the research is important.

"What's so exciting about this study is its use of electronic media to connect patients to integrative resources that might not be immediately available to them," he commented.

Patients in rural areas or economically underdeveloped urban areas, as well as those of low SES, may not easily tap into pain management strategies, said Jackson.

"Access to high-quality integrative pain management is often even more limited or nonexistent. So bringing ehealth modalities to these patients can be critical for success," he said.

Dr Gardiner has disclosed no relevant financial relationships. Dr Jackson is a consultant for Otsuka Pharmaceuticals and Aspire Healthcare.

Academy of Integrative Pain Management (AIPM) Inaugural Global Pain Clinician Summit 2018. Abstract, 3, presented November 9, 2018.

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