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The effect of a virtual pain coach on pain management discussions: a pilot study
Abstracts
H09 Other (436) Improvements in objective and subjective functioning following completion of an interdisciplinary pain rehabilitation program C Block, L Cianfrini, S Andrews, R McConley, and D Doleys; The Doleys Clinic Pain and Rehabilitation Institute, Birmingham, AL The benefits of interdisciplinary pain programs are well documented; however, coverage is denied by many payer systems. Further data are warranted to expand the evidence for such positive treatment outcomes. The present study examined outcome data for 75 patients who completed a four-week residential pain rehabilitation program. The program consists of appropriate medication adjustment (not necessarily opioid withdrawal), education, relaxation training, counseling, biofeedback, and physical therapy. Average age was 43.28 years (SD=9.25) with an average duration of 57.46 months from injury to program entry. The sample was 57.3% female and 86.3% Caucasian. Pre- to post-treatment outcomes were analyzed with repeated measures design. Results revealed significant reductions in psychological distress (e.g., Pain Anxiety Symptoms Scale; p<0.001, and Beck Depression Inventory; p<0.001, among others) and increase in pain acceptance (Chronic Pain Acceptance Questionnaire; p<0.001). Self-reported pain intensity significantly decreased (Numerical Rating Scale; p<0.001) and perceived functional impairment decreased (Oswestry Activity Rating Scale; p<0.001). Improvements in functional measures were also noted, including trunk range of motion (e.g., forward flexion, extension, etc.; all p<0.001) and timed 100 yard walk (p<0.001). Exercise tolerance increased by an average of 13.28% (SD=14.10). The majority of these effects were of moderate size (mean partial h2 = .47). Patients reported significant satisfaction at discharge, including improvements in mood (M=46.79%, SD=33.31), activity level (M=51.89%, SD=31.38), social interactions (M=37.29%, SD=34.47), coping self-efficacy (M=50.08%, SD=33.61), and pain intensity (M=25.32%, SD=27.79). It is interesting to note that significant psychological, pain, and functional improvements were observed, despite starting treatment on average almost 5 years post-injury and despite relatively stable medication dosing (i.e., there was a trend toward decreased morphine equivalent doses of opioid analgesics, p=0.06). This analysis provides further evidence that an interdisciplinary rehabilitation program can result in significant improvements in both subjective and objective functioning, independent of medication use and time since injury.
The Journal of Pain
P85
(437) The effect of a virtual pain coach on pain management discussions: a pilot study D McDonald, S Walsh, C Vergara, and T Gifford; University of Connecticut Storrs, CT The pain communication plus virtual pain coach intervention was tested in primary care for the effect on older adults’ communication of osteoarthritis pain information, practitioners’ pain management changes, and older adults’ reduced pain and depressive symptoms one month later. A randomized, controlled, pilot design was used. Twenty-three older adults with osteoarthritis pain were randomly assigned to the pain communication plus virtual pain coach or the pain communication-only group. The pain communication component was a 3-minute video of important osteoarthritis pain information. The coach component consisted of practicing out loud with a virtual pain coach programmed on a laptop computer. Pain and depressive symptoms were measured pre intervention and one month later via the BPI-SF and BDI-II. Immediately following the intervention older adults had their primary care visit, which was audio-taped, transcribed, and content analyzed for older adults’ communicated pain information and practitioners’ pain management changes. A priori criteria from the APS 2002 arthritis pain management guidelines were used to content analyze important pain information described by older adults (e.g. analgesic effectiveness), and pain management changes prescribed by practitioners (e.g. acetaminophen). Older adults in the pain communication plus virtual pain coach group described to practitioners significantly more pain source information, p = .009; and were prescribed 4.1 times more pain management changes, 95% CI = 1.5 – 11.1, p = .005, than older adults in the pain communication-only group. A clinically significant reduction in pain intensity, (baseline M = 3.8 (SD = 1.50), 1-month M = 3.2 (SD = 2.36)) and depressive symptoms (baseline M = 12.5 (SD = 5.39), 1-month M = 9.9 (SD = 5.80)) resulted only for older adults in the pain communication plus virtual pain coach group. The virtual pain coach presents an innovative way to improve pain management discussions between practitioners and older adults with persistent pain.
H09 Other (436) Improvements in objective and subjective functioning following completion of an interdisciplinary pain rehabilitation program C Block, L Cianfrini, S Andrews, R McConley, and D Doleys; The Doleys Clinic Pain and Rehabilitation Institute, Birmingham, AL The benefits of interdisciplinary pain programs are well documented; however, coverage is denied by many payer systems. Further data are warranted to expand the evidence for such positive treatment outcomes. The present study examined outcome data for 75 patients who completed a four-week residential pain rehabilitation program. The program consists of appropriate medication adjustment (not necessarily opioid withdrawal), education, relaxation training, counseling, biofeedback, and physical therapy. Average age was 43.28 years (SD=9.25) with an average duration of 57.46 months from injury to program entry. The sample was 57.3% female and 86.3% Caucasian. Pre- to post-treatment outcomes were analyzed with repeated measures design. Results revealed significant reductions in psychological distress (e.g., Pain Anxiety Symptoms Scale; p<0.001, and Beck Depression Inventory; p<0.001, among others) and increase in pain acceptance (Chronic Pain Acceptance Questionnaire; p<0.001). Self-reported pain intensity significantly decreased (Numerical Rating Scale; p<0.001) and perceived functional impairment decreased (Oswestry Activity Rating Scale; p<0.001). Improvements in functional measures were also noted, including trunk range of motion (e.g., forward flexion, extension, etc.; all p<0.001) and timed 100 yard walk (p<0.001). Exercise tolerance increased by an average of 13.28% (SD=14.10). The majority of these effects were of moderate size (mean partial h2 = .47). Patients reported significant satisfaction at discharge, including improvements in mood (M=46.79%, SD=33.31), activity level (M=51.89%, SD=31.38), social interactions (M=37.29%, SD=34.47), coping self-efficacy (M=50.08%, SD=33.61), and pain intensity (M=25.32%, SD=27.79). It is interesting to note that significant psychological, pain, and functional improvements were observed, despite starting treatment on average almost 5 years post-injury and despite relatively stable medication dosing (i.e., there was a trend toward decreased morphine equivalent doses of opioid analgesics, p=0.06). This analysis provides further evidence that an interdisciplinary rehabilitation program can result in significant improvements in both subjective and objective functioning, independent of medication use and time since injury.
The Journal of Pain
P85
(437) The effect of a virtual pain coach on pain management discussions: a pilot study D McDonald, S Walsh, C Vergara, and T Gifford; University of Connecticut Storrs, CT The pain communication plus virtual pain coach intervention was tested in primary care for the effect on older adults’ communication of osteoarthritis pain information, practitioners’ pain management changes, and older adults’ reduced pain and depressive symptoms one month later. A randomized, controlled, pilot design was used. Twenty-three older adults with osteoarthritis pain were randomly assigned to the pain communication plus virtual pain coach or the pain communication-only group. The pain communication component was a 3-minute video of important osteoarthritis pain information. The coach component consisted of practicing out loud with a virtual pain coach programmed on a laptop computer. Pain and depressive symptoms were measured pre intervention and one month later via the BPI-SF and BDI-II. Immediately following the intervention older adults had their primary care visit, which was audio-taped, transcribed, and content analyzed for older adults’ communicated pain information and practitioners’ pain management changes. A priori criteria from the APS 2002 arthritis pain management guidelines were used to content analyze important pain information described by older adults (e.g. analgesic effectiveness), and pain management changes prescribed by practitioners (e.g. acetaminophen). Older adults in the pain communication plus virtual pain coach group described to practitioners significantly more pain source information, p = .009; and were prescribed 4.1 times more pain management changes, 95% CI = 1.5 – 11.1, p = .005, than older adults in the pain communication-only group. A clinically significant reduction in pain intensity, (baseline M = 3.8 (SD = 1.50), 1-month M = 3.2 (SD = 2.36)) and depressive symptoms (baseline M = 12.5 (SD = 5.39), 1-month M = 9.9 (SD = 5.80)) resulted only for older adults in the pain communication plus virtual pain coach group. The virtual pain coach presents an innovative way to improve pain management discussions between practitioners and older adults with persistent pain.