September 07, 2021
3 minutes to read
Source / Disclosures
Disclosures: Darnall reports personal expenses as Chief Science Advisor at AppliedVR; royalties for books on the treatment of pain; a Patient-Centered Outcomes Research Institute (PCORI) research grant; Axial Healthcare consulting fees; member of the board of directors of the American Academy of Pain Medicine and the Institute for Brain Potential; be a scientific member of the NIH Interagency Pain Research Coordinating Committee, the Centers for Disease Control and Prevention Opioid Workgroup and the Pain Advisory Group of the American Psychological Association; and be a principal investigator for another NIH fellowship. Please see the study for relevant financial information from all other authors.
According to the data, a one-session pain management skills course was non-inferior to 8-week cognitive behavioral therapy and superior to a health education course, for catastrophic pain in patients with chronic low back pain.
“Chronic pain affects tens of millions of Americans, and chronic low back pain is the most common chronic pain,” Beth D. Darnall, PhD, from Stanford University School of Medicine, said Healio Rheumatology. “Access to non-pharmacological pain care remains limited for many patients. Even where access is possible, multi-session treatment formats can be patient infeasible or undesirable. Effective and accessible solutions are needed to ensure equitable access to effective pain care.
Write in JAMA network open, Darnall and colleagues described how they developed a 2-hour, one-session course called “Empowered Relief” to quickly equip individuals with self-management skills in pain. According to the researchers, the program “incorporates pain education, self-regulatory skills (ie relaxation, cognitive reframing and self-healing) and the principles of mindfulness.”
However, a comparison between enhanced relief and cognitive behavioral therapy has yet to be tested in a randomized clinical trial, while the durability and extent of the treatment’s impacts are unknown, they wrote. To examine how the one-class stand-alone rescue program compares to the eight-session cognitive behavioral therapy strategy, or health education, in terms of pain catastrophism, intensity, and interference, along with other findings, Darnall and his colleagues conducted a randomized clinical trial.
Beth D. Darnall
Participants were recruited from a single university center in the San Francisco Bay Area. The inclusion criteria were axial low back pain experienced for at least half a day in the past 6 months, an average pain intensity score of at least four on a scale of 0 to 10, control of l English, age 18 to 70, the Pain Catastrophic Scale score of at least 20, and the ability to attend eight 2-hour sessions.
People with gross cognitive impairment, radicular symptoms, previous exposure to rescue therapy or cognitive behavioral therapy in the past 3 years, current substance use disorder, forensic factors , suicidal ideation or severe depression were excluded.
A total of 263 participants were randomly assigned to three groups, of which 87 enrolled in the empowered rescue program, 88 received eight sessions of cognitive behavioral therapy, and 88 received health education. Self-reported participant data were collected at baseline, before treatment, and at months 1, 2, and 3 after treatment, from May 24, 2017 to March 3, 2020. The primary outcome was group differences in scale score. of pain catastrophism at 3 months. after treatment, pain intensity and interference were defined as priority secondary endpoints.
According to the researchers, enhanced relief was not inferior to cognitive behavioral therapy for 3-month pain catastrophism scores (difference = 1.39; 97.5% CI, – at 4.24). Meanwhile, enhanced relief (difference = –5.9; 95% CI, -8.78 to –3.01) and cognitive behavioral therapy (difference = –7.29; 95% CI, – 10.20 to –4.38) were superior to health education for pain catastrophism scores.
“We also found that the single-session pain class had broad impacts, including significant reductions in pain intensity, pain interference, pain distress, ‘anxiety, depression, sleep disturbances and fatigue at 3 months,’ Darnall said. Healio Rheumatology.
Reductions in catastrophic pain score for enhanced relief (-9.12; 95% CI, -11.6 to – 6.67) and cognitive behavioral therapy (-10.94; 95% CI, – 13.6 to -8.32) at 3 months after treatment were clinically significant. The reduction in the health education score was –4.6 (95% CI, –7.18 to –2.01).
The researchers adjusted the comparisons between groups for baseline pain catastrophism scores and used intention-to-treat analysis. In this analysis, enhanced relief was not inferior to cognitive behavioral therapy for pain intensity and pain interference, as well as for sleep disturbance, pain discomfort, behavior. painful, depression and anxiety. However, the empowered relief program was inferior to cognitive behavioral therapy for physical function.
“Our study provides evidence that a one-session pain relief techniques course – Empowered Relief – can be a very effective way for some patients to achieve significant relief,” Darnall said. “We need to provide people with ongoing pain quick access to information and skills that will help them better manage pain and associated symptoms. Our current model of offering behavioral pain treatments later – or not at all – perpetuates suffering and disparities in pain management. The results of our study indicate a promising solution.
She later added: “We hope to conduct a national benchmarking study on the effectiveness of Empowered Relief in 2022, as well as test its integration into primary care settings. “