Abstract
Introduction: Globally, chronic pain affects more than 30% of people worldwide and is the leading cause of disability and health care utilisation. Access to timely, person-centred, cost-effective programs is unattainable for most. People living in regional, rural and remote areas are disproportionately affected due to scarcity of services and qualified, multidisciplinary health and medical professionals. Caring and supporting people with chronic pain involves a range of interventions that incorporate a multifaceted bio-psychosocial approach. Tertiary and primary chronic pain services are optimally placed to deliver integrated models of care. This pilot study explored the effectiveness of an integrated Guided Self-Help (GSH) program within a multidisciplinary tertiary pain unit in a public hospital in Australia.
Methods: A service delivery evaluation was undertaken and a pilot study implemented to determine feasibility and useability of an integrated GSH program for people with chronic pain. A single-group pre–post evaluation was provided to a convenience sample of 42 people referred to the Flinders Medical Centre Pain Management Unit (FMC PMU). Delivered via telehealth or in person by postgraduate students, a manualised GSH workbook was utilised to support adherence and fidelity. Content included goal setting, pain conceptualisation, psychoeducation, activity scheduling, pacing and cognitive strategies. The purpose of the integrated GSH pilot program was to support participants in gaining increased pain literacy, knowledge of effective physical and psychological strategies and enhance self-management of their chronic pain. Levels of psychological distress (PHQ-9 and GAD-7), pain catastrophising (PCS), and pain severity/interference (BPI) were assessed at the beginning and end of support. Integrating the program within a multidisciplinary pain unit intended to facilitate and provide participants with an understanding of their pain through a psychosocial lens, build self-efficacy, and recognise the benefits of other non-medical supports to manage their chronic pain in the future. Outcome data were routinely collected as part of FMC PMU usual practice for clinical and quality assurance purposes, then analysed retrospectively. Thus, under the National Health and Medical Research Council (NHMRC) Ethical Considerations in Quality Assurance and Evaluation Activities guidelines (NHMRC, 2014), and verified by the Southern Adelaide Local Health Network (SALHN) Research Committee (our institutional review board) via email (dated 10/09/2020), ethical review and approval were not required for this project as it constituted a quality improvement activity – specifically, a service delivery evaluation. This project is registered with the SALHN Quality Library (for quality assurance activities that are exempt from ethical approval) (Quality Register ID 3390).
Results: Participants showed statistically significant improvements on the PHQ-9 [i.e., mean drop of 2.85 (t = 3.16)], GAD [mean drop of 2.52 (t = 2.71)], and PCS [mean drop of 7.77 (t = 3.47)] with small-to-moderate effect sizes. BPI scores did not change. Results were similar when stratifying analyses by those who completed 2–5 versus 6–12 sessions.
Conclusion: Integrating a GSH program for people with chronic pain into a multidisciplinary tertiary pain clinic is an efficacious and scalable way to increase access to effective strategies that can increase self-efficacy and self-management. Novel, scalable, and effective solutions are needed to improve quality of life and address disparities for people with chronic pain. The psychological shifts and benefits observed support efficacy towards self-management strategies that can increase autonomy and quality of life.
| Original language | English |
|---|---|
| Pages (from-to) | 449-460 |
| Number of pages | 12 |
| Journal | Pain and Therapy |
| Volume | 12 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Apr 2023 |
Bibliographical note
Funding Information:The authors would like to acknowledge the participants who were willing to engage in the FMC-PMU GSH pilot study and are appreciative of their time, efforts, and willingness to take up the support from supervised coaches. We would also like to thank Dr. Porhan Kang, Dr. David Smith, Ruby Wolinska, Samantha Casiero, Jacob Mottram and Ashley Grant. No funding or sponsorship was received for this study or publication of this article. The journal’s Rapid Service Fee was funded by the authors. All authors were involved in the concept design and drafting of the manuscript. Amelia Searle, Anthony Venning, and Cindy Wall undertook the statistical analysis. Australian Association of Cognitive Behaviour Therapists (AACBT) 40th National conference, 24th-26th October 2019. Adelaide, South Australia, Australia. Low Intensity Cognitive Behavioural Therapy for Adult Chronic Pain Patients: Preliminary Pilot Data and Lessons Learned. (2019). Wall, C., Venning, A., Redpath P., Herriot P., Smith D., Glover F., Oswald, T., Wolinska, R., Casiero, S and Searle, A. Paula Redpath, Fiona Glover, Cindy Wall and Anthony Venning developed the GSH workbook used in the pilot study – ‘Rethinking Pain’. Fiona Glover and Cindy Wall provided clinical supervision for the coaches in the FMC-PMU. Amelia Searle and Peter Herriot have nothing to disclose. Tassia Oswald is now affiliated with Kings Together Public Mental Health Initiative Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience. King’s College London. London. Outcomes data were routinely collected as part of FMC PMU usual practice for clinical and quality assurance purposes, then analysed retrospectively. Thus, under the National Health and Medical Research Council (NHMRC) Ethical Considerations in Quality Assurance and Evaluation Activities guidelines (NHMRC, 2014), and verified by the Southern Adelaide Local Health Network (SALHN) Research Committee (our institutional review board) via email (dated 10/09/2020), ethical review and approval were not required for this project as it constituted a quality improvement activity – specifically, a service delivery evaluation. This project is registered with the SALHN Quality Library (for quality assurance activities that are exempt from ethical approval) (Quality Register ID 3390). The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.
Publisher Copyright:
© 2023, The Author(s).