CP pilot results

A pilot study to assess the effectiveness of a brief lay-led self-management education programme for patients with chronic pain.

Authors

Andreae-Jones SA (Associate Specialist, Bath Pain Services), Cowlard J (Training Services Manager, Arthritis Care), Taylor M (Consultant in pain management, Eric Angel pain management centre, Derriford Hospital, Plymouth), Taylor A (Cardiff University), Undy MB, Senior Statistics Lecturer (retired), University of Plymouth

1. Introduction

Arthritis is the most frequent cause of pain, and pain is the main reason people visit their GP.

Recent research has highlighted a demand for a new shorter self-management programme focused on pain.

In 2004, working in partnership with medical pain specialists in Plymouth, Devon, Arthritis Care staff developed a new pain-management workshop and manual called Challenging Pain.

Challenging Pain is aimed at people with chronic pain, and therefore of value to people with a wider range of conditions.

The workshop introduces participants to a variety of cognitive pain management techniques such as; relaxation, breathing techniques, communication skills and the benefits of exercise. It is designed as an adjunct to the care and support people with pain receive from their health specialists.

The purpose of this study was to evaluate the effectiveness of Challenging Pain

2. Method

Participants were referred onto the programme by GPs, Pain Clinic Pain Education Programme waiting lists or through self referral.

A total of 186 people with chronic pain participated in 18 workshops. Each workshop consists of 2.5 hour sessions delivered over 2 weeks by trained lay personnel that also live with chronic pain. The quality of workshop delivery was assured by no notice assessments.

Evaluations were conducted pre-workshop and at six and twelve months later using assessment tools and outcome measures adapted from Lorig’s work including; questionnaires covering a variety of bio-psychosocial aspects of chronic pain and focus group discussions (Lorig et al 1999).

3. Results

6-month follow-up questionnaire 158 (84.9%) participants completed.

12-month follow-up questionnaire 106 (67.1%) participants completed Using Wilcoxon signed rank tests, the data indicates that after 12 months there are statistically significant changes in:

• Pain scores - were reduced 14%
• Average number of GP visits was reduced by 23%
• Health distress was reduced by 31%
• Self-efficacy was improved by 27%

Focus group discussions: 20 participants took part in pre and post focus groups. Pre-workshop participants reported that they:

• Had no one to turn to, they often felt desperate
• Felt isolated and not understood
• Wanted specific advice (e.g. for exercise)

Post-workshop participants reported that they:

• Benefited by meeting others with similar problems
• Related well with lay trainers because they understood pain from personal experience
• Improved their self confidence in dealing with their pain

4. Conclusions

This pilot study demonstrates that the Challenging Pain self-management intervention has a lot to offer chronic pain patients.

The results indicate that Challenging Pain significantly reduces health care visits and health distress while self-efficacy is improved and the changes are sustained at 6 and 12 months.

In comparison with the 6-week self-management programmes (Lorig et al 2001, Buszewicz et al 2006) this pilot study has shown the two-week programme is as effective.

Therefore the brevity and cost effectiveness of Challenging Pain are considerable strengths of the product.

5. Recommendations

An extended follow up and a larger study could yield more robust statistical data in support of Challenging Pain.

It is recommended that Challenging Pain is offered to patients with chronic pain as a cost effective pain management intervention within the patient’s health care pathway

A GP who referred patients to the programme said-

'My patients who have attended the Challenging Pain workshops have been impressed, and have found them very helpful'

A participant said-

'I was upset at being diagnosed, but after attending the Challenging Pain workshops I feel more confident and able to deal with my condition much better'