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Evaluation of the online chronic pain management program
Abstracts
The Journal of Pain
P73
G04 Other
(390) Pain inhibition in Fibromyalgia
(388) Withdrawn
K Thieme, R Gracely, S Folger, M Tommerdahl, G Essick, M Young, O Monbureau, R Kniesche, T Pinkpank, V Miller, S Day, J Holden, and W Maixner; University of North Carolina, Chapel Hill, NC An important component of intrinsic pain regulatory systems is defined by cardiovascular dynamics that influence baroreceptor sensitivity (BRS). In healthy individuals, an elevation in resting arterial blood pressure is inversely related to pain sensitivity. This study tested: (1) whether this relationship is altered in fibromyalgia (FM) and (2) whether the introduction of noxious and non-noxious electrical stimuli introduced during systolic and diastolic phases of the cardiac cycle influence pain perception. Thirty pain-free normotensives (HC) and 30 FM experienced three 8-minutes-trials where sensory stimuli and stimuli of 50% and 75% of the electrical pain tolerance (SP protocol) were administered to ring and index finger in randomized order. Participants also experience three trials with only painful electrical stimuli (P protocol). Before, between and after the test trials, clinical pain, sensory, pain and tolerance thresholds to electrical stimuli were assessed. Blood pressure (BP), BRS, and evoked potentials were measured throughout the session. When compared to the diastolic phase, N50, N150 and P260 responses were diminished during the systolic phase in HC (p<0.005) but not in FM. BRS was diminished in FM compared to HC (p<0.01). The P260 and P390, but not N50 and N150, showed greater responses in FM compared to HC during the SP protocol compared to the P protocol (all p’s<0.005). Pain and tolerance threshold increased by 23.4% and 31.2% in FM during the SP protocol and correlated with increases in BP and BRS and decreases in clinical pain (all p’s<0.01). In contrast, during the P protocol pain and tolerance thresholds were associated with greater N150 activity but not P260 and P390 activity or blood pressure. Despite the diminished BRS in FM, a combination of electrical pain with pain-free stimuli applied during the cardiac cycle can diminish pain sensitivity and reduce fibromyalgia pain suggesting an intrinsic operant conditioning of BRS.
H. Treatment Approaches (Psychosocial & Cognitive) H01 Cognitive/Behavioral Approaches (389) The impact of direct versus indirect exposure to chronic pain on beliefs about negative life impact, support provision, pain treatment, and providers M Skinner, P Cowan, and D Turk; University of Washington, Seattle, WA Negative beliefs about support, treatments, and providers, can impact the experience of chronic pain. Although a number of surveys have focused on beliefs of people with pain (PWP) and the general population (GP), little attention has been given to those indirectly exposed to pain – caregivers (Cs). The role of direct vs. indirect exposure in Cs and GP may have 1 of 2 effects: 1) contribute to negative belief or 2) familiarity may reduce negative beliefs. In the former, attention should remain on PWPs; whereas if the latter, preemptive education for Cs and the GP would be desirable to increase empathy. This study investigated the impact of exposure/familiarity to pain by surveying - PWP (n=317), Cs (n=258); GP (n=1003). A random, digit-dial telephone survey was conducted with approximately 100,000 households. Those who met criteria and volunteered were interviewed regarding pain beliefs embedded in a longer interview. Participants rated beliefs about negative life impact, support and criticism, medications, symptoms, and providers. A MANOVA revealed a significant effect (F (12, 3140) = 100.76, p = 0.001). Post Hoc analysis revealed that the GP believed that PWP received less support and more criticism, had more symptoms, more negative views of medications and providers, and more negative life impact (p < 0.05) than PWP and Cs. PWP reported less negative life impact, lower symptoms, more support and less criticism than Cs (p < 0.05). Results suggest that the GP holds more negative beliefs than PWP and Cs. Furthermore, PWP hold less negative views than Cs. Paradoxically, direct knowledge appears to reduce negative beliefs. Research needs to investigate the basis for discrepancies and develop strategies to educate the GP and Cs about chronic pain. Support for this survey was provided by a grant to the American Chronic Pain Association (ACPA) from King Pharmaceuticals.
(391) Evaluation of the online chronic pain management program L Ruehlman, P Karoly, and C Enders; Consultants in Behavioral Research, Tempe, AZ Increasingly, individuals with chronic illnesses, including pain, search the internet for health-related information and assistance. The type of available help ranges from text-based, information-only sites to custom-built software applications. The flexibility of online applications allows for the use of multimedia, as opposed to pure text-based presentation of information, user interactivity, the ability to collect, score, store, and report user data to provide a tailored user experience, inclusion of social networking such as forums and webinars, and opportunities for virtual friendships to develop. In contrast to the static nature of self-help books, CD-ROMS, or DVDs, online programs have the distinct advantage of agile modification of content and functionality. The Chronic Pain Management Program is a comprehensive, online pain management system that utilizes each of the aforementioned capabilities. Program content and functionality were derived from cognitive, behavioral, interpersonal, and self-management approaches to chronic pain management. Evidence-based approaches within these theoretical models were identified and transformed to an online format. The present study tested the efficacy of the Program with 305 individuals (196 female, 109 male) with chronic pain. A total of 162 were randomly assigned to use the Program; 143 to the wait list control group. A comprehensive assessment was administered prior to the study, and at approximately 7 and 14 weeks. All data collection and participant involvement took place online. Intent-to-treat analysis was employed using linear growth models as the primary analytic tool for the study. Results indicated that utilization of the Program was associated with significant decreases in pain severity, pain-related interference, emotional burden, perceived disability, catastrophizing, and pain induced fear. Further, the experimental group displayed significant reductions in stress, anxiety, and depression, as well as increased knowledge about the principles of chronic pain and its management. Supported by grants from the National Institute of Neurological Disorders and Stroke.
The Journal of Pain
P73
G04 Other
(390) Pain inhibition in Fibromyalgia
(388) Withdrawn
K Thieme, R Gracely, S Folger, M Tommerdahl, G Essick, M Young, O Monbureau, R Kniesche, T Pinkpank, V Miller, S Day, J Holden, and W Maixner; University of North Carolina, Chapel Hill, NC An important component of intrinsic pain regulatory systems is defined by cardiovascular dynamics that influence baroreceptor sensitivity (BRS). In healthy individuals, an elevation in resting arterial blood pressure is inversely related to pain sensitivity. This study tested: (1) whether this relationship is altered in fibromyalgia (FM) and (2) whether the introduction of noxious and non-noxious electrical stimuli introduced during systolic and diastolic phases of the cardiac cycle influence pain perception. Thirty pain-free normotensives (HC) and 30 FM experienced three 8-minutes-trials where sensory stimuli and stimuli of 50% and 75% of the electrical pain tolerance (SP protocol) were administered to ring and index finger in randomized order. Participants also experience three trials with only painful electrical stimuli (P protocol). Before, between and after the test trials, clinical pain, sensory, pain and tolerance thresholds to electrical stimuli were assessed. Blood pressure (BP), BRS, and evoked potentials were measured throughout the session. When compared to the diastolic phase, N50, N150 and P260 responses were diminished during the systolic phase in HC (p<0.005) but not in FM. BRS was diminished in FM compared to HC (p<0.01). The P260 and P390, but not N50 and N150, showed greater responses in FM compared to HC during the SP protocol compared to the P protocol (all p’s<0.005). Pain and tolerance threshold increased by 23.4% and 31.2% in FM during the SP protocol and correlated with increases in BP and BRS and decreases in clinical pain (all p’s<0.01). In contrast, during the P protocol pain and tolerance thresholds were associated with greater N150 activity but not P260 and P390 activity or blood pressure. Despite the diminished BRS in FM, a combination of electrical pain with pain-free stimuli applied during the cardiac cycle can diminish pain sensitivity and reduce fibromyalgia pain suggesting an intrinsic operant conditioning of BRS.
H. Treatment Approaches (Psychosocial & Cognitive) H01 Cognitive/Behavioral Approaches (389) The impact of direct versus indirect exposure to chronic pain on beliefs about negative life impact, support provision, pain treatment, and providers M Skinner, P Cowan, and D Turk; University of Washington, Seattle, WA Negative beliefs about support, treatments, and providers, can impact the experience of chronic pain. Although a number of surveys have focused on beliefs of people with pain (PWP) and the general population (GP), little attention has been given to those indirectly exposed to pain – caregivers (Cs). The role of direct vs. indirect exposure in Cs and GP may have 1 of 2 effects: 1) contribute to negative belief or 2) familiarity may reduce negative beliefs. In the former, attention should remain on PWPs; whereas if the latter, preemptive education for Cs and the GP would be desirable to increase empathy. This study investigated the impact of exposure/familiarity to pain by surveying - PWP (n=317), Cs (n=258); GP (n=1003). A random, digit-dial telephone survey was conducted with approximately 100,000 households. Those who met criteria and volunteered were interviewed regarding pain beliefs embedded in a longer interview. Participants rated beliefs about negative life impact, support and criticism, medications, symptoms, and providers. A MANOVA revealed a significant effect (F (12, 3140) = 100.76, p = 0.001). Post Hoc analysis revealed that the GP believed that PWP received less support and more criticism, had more symptoms, more negative views of medications and providers, and more negative life impact (p < 0.05) than PWP and Cs. PWP reported less negative life impact, lower symptoms, more support and less criticism than Cs (p < 0.05). Results suggest that the GP holds more negative beliefs than PWP and Cs. Furthermore, PWP hold less negative views than Cs. Paradoxically, direct knowledge appears to reduce negative beliefs. Research needs to investigate the basis for discrepancies and develop strategies to educate the GP and Cs about chronic pain. Support for this survey was provided by a grant to the American Chronic Pain Association (ACPA) from King Pharmaceuticals.
(391) Evaluation of the online chronic pain management program L Ruehlman, P Karoly, and C Enders; Consultants in Behavioral Research, Tempe, AZ Increasingly, individuals with chronic illnesses, including pain, search the internet for health-related information and assistance. The type of available help ranges from text-based, information-only sites to custom-built software applications. The flexibility of online applications allows for the use of multimedia, as opposed to pure text-based presentation of information, user interactivity, the ability to collect, score, store, and report user data to provide a tailored user experience, inclusion of social networking such as forums and webinars, and opportunities for virtual friendships to develop. In contrast to the static nature of self-help books, CD-ROMS, or DVDs, online programs have the distinct advantage of agile modification of content and functionality. The Chronic Pain Management Program is a comprehensive, online pain management system that utilizes each of the aforementioned capabilities. Program content and functionality were derived from cognitive, behavioral, interpersonal, and self-management approaches to chronic pain management. Evidence-based approaches within these theoretical models were identified and transformed to an online format. The present study tested the efficacy of the Program with 305 individuals (196 female, 109 male) with chronic pain. A total of 162 were randomly assigned to use the Program; 143 to the wait list control group. A comprehensive assessment was administered prior to the study, and at approximately 7 and 14 weeks. All data collection and participant involvement took place online. Intent-to-treat analysis was employed using linear growth models as the primary analytic tool for the study. Results indicated that utilization of the Program was associated with significant decreases in pain severity, pain-related interference, emotional burden, perceived disability, catastrophizing, and pain induced fear. Further, the experimental group displayed significant reductions in stress, anxiety, and depression, as well as increased knowledge about the principles of chronic pain and its management. Supported by grants from the National Institute of Neurological Disorders and Stroke.