J. Med. Internet Res. - Effects of an individually tailored Web-based chronic pain management program on pain severity, psychological health, and functioning.


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CKGROUND: It is estimated that 30% of adults in the United States experience daily chronic pain. This results in a significant burden on the health care system, in particular primary care, and on the workplace. Chronic pain management with cognitive-behavioral psychological treatment is effective in reducing pain intensity and interference, health-related quality of life, mood, and return to work. However, the population of individuals with chronic pain far exceeds the population of therapists that can provide this care face-to-face. The use of tailored, Web-based interventions for the management of chronic pain could address limitations to access by virtue of its unlimited scalability.OBJECTIVE: To examine the effects of a tailored Web-based chronic pain management program on subjective pain, activity and work interference, quality of life and health, and stress.METHODS: Eligible participants accessed the online pain management program and informed consent via participating employer or health care benefit systems; program participants who completed baseline, 1-, and 6-month assessments were included in the study. Of the 645 participants, the mean age was 56.16 years (SD 12.83), most were female (447/645, 69.3%), and white (505/641, 78.8%). Frequent pain complaints were joint (249/645, 38.6%), back (218/645, 33.8%), and osteoarthritis (174/654, 27.0%). The online pain management program used evidence-based theories of cognitive behavioral intervention, motivational enhancement, and health behavior change to address self-management, coping, medical adherence, social support, comorbidities, and productivity. The program content was individually tailored on several relevant participant variables.RESULTS: Both pain intensity (mean 5.30, SD 2.46), and unpleasantness (mean 5.43, SD 2.52) decreased significantly from baseline to 1-month (mean 4.16, SD 2.69 and mean 4.24, 2.81, respectively) and 6-month (mean 3.78, SD 2.79 and mean 3.78, SD 2.79, respectively) assessments (P<.001). The magnitude of the 6-month effects were large. Trends for decreases in pain interference (36.8% reported moderate or enormous interference) reached significance at 6 months (28.9%, P<.001). The percentage of the sample reporting fair or poor quality of life decreased significantly from 20.6% at baseline to 16.5% at 6 months (P=.006).CONCLUSIONS: Results suggest that the tailored online chronic pain management program showed promising effects on pain at 1 and 6 months posttreatment and quality of life at 6 months posttreatment in this naturalistic study. Further research is warranted to determine the significance and magnitude of the intervention's effects in a randomized controlled trial.

Resumo Limpo

ckground estim adult unit state experi daili chronic pain result signific burden health care system particular primari care workplac chronic pain manag cognitivebehavior psycholog treatment effect reduc pain intens interfer healthrel qualiti life mood return work howev popul individu chronic pain far exceed popul therapist can provid care facetofac use tailor webbas intervent manag chronic pain address limit access virtu unlimit scalabilityobject examin effect tailor webbas chronic pain manag program subject pain activ work interfer qualiti life health stressmethod elig particip access onlin pain manag program inform consent via particip employ health care benefit system program particip complet baselin month assess includ studi particip mean age year sd femal white frequent pain complaint joint back osteoarthr onlin pain manag program use evidencebas theori cognit behavior intervent motiv enhanc health behavior chang address selfmanag cope medic adher social support comorbid product program content individu tailor sever relev particip variablesresult pain intens mean sd unpleas mean sd decreas signific baselin month mean sd mean respect month mean sd mean sd respect assess p magnitud month effect larg trend decreas pain interfer report moder enorm interfer reach signific month p percentag sampl report fair poor qualiti life decreas signific baselin month pconclus result suggest tailor onlin chronic pain manag program show promis effect pain month posttreat qualiti life month posttreat naturalist studi research warrant determin signific magnitud intervent effect random control trial

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