Randomized Trial of Chronic Pain Self-Management Program in the Community or Clinic for Low-Income Primary Care Patients

Barbara J. Turner, Yuanyuan Liang, Maureen J. Simmonds, Natalia Rodriguez, Raudel Bobadilla, Zenong Yin

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Patients with chronic pain often lack the skills and resources necessary to manage this disease. Objective: To develop a chronic pain self-management program reflecting community stakeholders’ priorities and to compare functional outcomes from training in two settings. Design: A parallel-group randomized trial. Participants: Eligible subjects were 35–70 years of age, with chronic non-cancer pain treated with opioids for >2 months at two primary care and one HIV clinic serving low-income Hispanics. Interventions: In one study arm, the 6-month program was delivered in monthly one-on-one clinic meetings by a community health worker (CHW) trained as a chronic pain health educator, and in the second arm, content experts gave eight group lectures in a nearby library. Main Measures: Five times Sit-to-Stand test (5XSTS) assessed at baseline and 3 and 6 months. Other reported physical and cognitive measures include the 6-Min Walk (6 MW), Borg Perceived Effort Test (Borg Effort), 50-ft Speed Walk (50FtSW), SF-12 Physical Component Summary (SF-12 PCS), Patient-Specific Functional Scale (PSFS), and Symbol–Digit Modalities Test (SDMT). Intention-to-treat (ITT) analyses in mixed-effects models adjust for demographics, body mass index, maximum pain, study arm, and measurement time. Multiple imputation was used for sensitivity analyses. Key Results: Among 111 subjects, 53 were in the clinic arm and 58 in the community arm. In ITT analyses at 6 months, subjects in both arms performed the 5XSTS test faster (−4.9 s, P = 0.001) and improved scores on Borg Effort (−1, P = 0.02), PSFS (1.6, P < 0.001), and SDMT (5.9, P < 0.001). Only the clinic arm increased the 6 MW (172.4 ft, P = 0.02) and SF-12 PCS (6.2 points, P < 0.001). 50ftSW did not change (P = 0.15). Results were similar with multiple imputation. Five falls were possible adverse events. Conclusions: In low-income subjects with chronic pain, physical and cognitive function improved significantly after self-management training from expert lectures in the community and in-clinic meetings with a trained health educator.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalJournal of General Internal Medicine
DOIs
StateAccepted/In press - Jan 3 2018

Fingerprint

Pain Management
Self Care
Chronic Pain
Primary Health Care
Health Educators
Intention to Treat Analysis
Pain
Hispanic Americans
Cognition
Opioid Analgesics
Libraries
Body Mass Index
Demography
HIV

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Randomized Trial of Chronic Pain Self-Management Program in the Community or Clinic for Low-Income Primary Care Patients. / Turner, Barbara J.; Liang, Yuanyuan; Simmonds, Maureen J.; Rodriguez, Natalia; Bobadilla, Raudel; Yin, Zenong.

In: Journal of General Internal Medicine, 03.01.2018, p. 1-10.

Research output: Contribution to journalArticle

Turner, Barbara J. ; Liang, Yuanyuan ; Simmonds, Maureen J. ; Rodriguez, Natalia ; Bobadilla, Raudel ; Yin, Zenong. / Randomized Trial of Chronic Pain Self-Management Program in the Community or Clinic for Low-Income Primary Care Patients. In: Journal of General Internal Medicine. 2018 ; pp. 1-10.
@article{1911a26df69f48d4aef04d39c24f0083,
title = "Randomized Trial of Chronic Pain Self-Management Program in the Community or Clinic for Low-Income Primary Care Patients",
abstract = "Background: Patients with chronic pain often lack the skills and resources necessary to manage this disease. Objective: To develop a chronic pain self-management program reflecting community stakeholders’ priorities and to compare functional outcomes from training in two settings. Design: A parallel-group randomized trial. Participants: Eligible subjects were 35–70 years of age, with chronic non-cancer pain treated with opioids for >2 months at two primary care and one HIV clinic serving low-income Hispanics. Interventions: In one study arm, the 6-month program was delivered in monthly one-on-one clinic meetings by a community health worker (CHW) trained as a chronic pain health educator, and in the second arm, content experts gave eight group lectures in a nearby library. Main Measures: Five times Sit-to-Stand test (5XSTS) assessed at baseline and 3 and 6 months. Other reported physical and cognitive measures include the 6-Min Walk (6 MW), Borg Perceived Effort Test (Borg Effort), 50-ft Speed Walk (50FtSW), SF-12 Physical Component Summary (SF-12 PCS), Patient-Specific Functional Scale (PSFS), and Symbol–Digit Modalities Test (SDMT). Intention-to-treat (ITT) analyses in mixed-effects models adjust for demographics, body mass index, maximum pain, study arm, and measurement time. Multiple imputation was used for sensitivity analyses. Key Results: Among 111 subjects, 53 were in the clinic arm and 58 in the community arm. In ITT analyses at 6 months, subjects in both arms performed the 5XSTS test faster (−4.9 s, P = 0.001) and improved scores on Borg Effort (−1, P = 0.02), PSFS (1.6, P < 0.001), and SDMT (5.9, P < 0.001). Only the clinic arm increased the 6 MW (172.4 ft, P = 0.02) and SF-12 PCS (6.2 points, P < 0.001). 50ftSW did not change (P = 0.15). Results were similar with multiple imputation. Five falls were possible adverse events. Conclusions: In low-income subjects with chronic pain, physical and cognitive function improved significantly after self-management training from expert lectures in the community and in-clinic meetings with a trained health educator.",
author = "Turner, {Barbara J.} and Yuanyuan Liang and Simmonds, {Maureen J.} and Natalia Rodriguez and Raudel Bobadilla and Zenong Yin",
year = "2018",
month = "1",
day = "3",
doi = "10.1007/s11606-017-4244-2",
language = "English (US)",
pages = "1--10",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",

}

TY - JOUR

T1 - Randomized Trial of Chronic Pain Self-Management Program in the Community or Clinic for Low-Income Primary Care Patients

AU - Turner, Barbara J.

AU - Liang, Yuanyuan

AU - Simmonds, Maureen J.

AU - Rodriguez, Natalia

AU - Bobadilla, Raudel

AU - Yin, Zenong

PY - 2018/1/3

Y1 - 2018/1/3

N2 - Background: Patients with chronic pain often lack the skills and resources necessary to manage this disease. Objective: To develop a chronic pain self-management program reflecting community stakeholders’ priorities and to compare functional outcomes from training in two settings. Design: A parallel-group randomized trial. Participants: Eligible subjects were 35–70 years of age, with chronic non-cancer pain treated with opioids for >2 months at two primary care and one HIV clinic serving low-income Hispanics. Interventions: In one study arm, the 6-month program was delivered in monthly one-on-one clinic meetings by a community health worker (CHW) trained as a chronic pain health educator, and in the second arm, content experts gave eight group lectures in a nearby library. Main Measures: Five times Sit-to-Stand test (5XSTS) assessed at baseline and 3 and 6 months. Other reported physical and cognitive measures include the 6-Min Walk (6 MW), Borg Perceived Effort Test (Borg Effort), 50-ft Speed Walk (50FtSW), SF-12 Physical Component Summary (SF-12 PCS), Patient-Specific Functional Scale (PSFS), and Symbol–Digit Modalities Test (SDMT). Intention-to-treat (ITT) analyses in mixed-effects models adjust for demographics, body mass index, maximum pain, study arm, and measurement time. Multiple imputation was used for sensitivity analyses. Key Results: Among 111 subjects, 53 were in the clinic arm and 58 in the community arm. In ITT analyses at 6 months, subjects in both arms performed the 5XSTS test faster (−4.9 s, P = 0.001) and improved scores on Borg Effort (−1, P = 0.02), PSFS (1.6, P < 0.001), and SDMT (5.9, P < 0.001). Only the clinic arm increased the 6 MW (172.4 ft, P = 0.02) and SF-12 PCS (6.2 points, P < 0.001). 50ftSW did not change (P = 0.15). Results were similar with multiple imputation. Five falls were possible adverse events. Conclusions: In low-income subjects with chronic pain, physical and cognitive function improved significantly after self-management training from expert lectures in the community and in-clinic meetings with a trained health educator.

AB - Background: Patients with chronic pain often lack the skills and resources necessary to manage this disease. Objective: To develop a chronic pain self-management program reflecting community stakeholders’ priorities and to compare functional outcomes from training in two settings. Design: A parallel-group randomized trial. Participants: Eligible subjects were 35–70 years of age, with chronic non-cancer pain treated with opioids for >2 months at two primary care and one HIV clinic serving low-income Hispanics. Interventions: In one study arm, the 6-month program was delivered in monthly one-on-one clinic meetings by a community health worker (CHW) trained as a chronic pain health educator, and in the second arm, content experts gave eight group lectures in a nearby library. Main Measures: Five times Sit-to-Stand test (5XSTS) assessed at baseline and 3 and 6 months. Other reported physical and cognitive measures include the 6-Min Walk (6 MW), Borg Perceived Effort Test (Borg Effort), 50-ft Speed Walk (50FtSW), SF-12 Physical Component Summary (SF-12 PCS), Patient-Specific Functional Scale (PSFS), and Symbol–Digit Modalities Test (SDMT). Intention-to-treat (ITT) analyses in mixed-effects models adjust for demographics, body mass index, maximum pain, study arm, and measurement time. Multiple imputation was used for sensitivity analyses. Key Results: Among 111 subjects, 53 were in the clinic arm and 58 in the community arm. In ITT analyses at 6 months, subjects in both arms performed the 5XSTS test faster (−4.9 s, P = 0.001) and improved scores on Borg Effort (−1, P = 0.02), PSFS (1.6, P < 0.001), and SDMT (5.9, P < 0.001). Only the clinic arm increased the 6 MW (172.4 ft, P = 0.02) and SF-12 PCS (6.2 points, P < 0.001). 50ftSW did not change (P = 0.15). Results were similar with multiple imputation. Five falls were possible adverse events. Conclusions: In low-income subjects with chronic pain, physical and cognitive function improved significantly after self-management training from expert lectures in the community and in-clinic meetings with a trained health educator.

UR - http://www.scopus.com/inward/record.url?scp=85040013959&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040013959&partnerID=8YFLogxK

U2 - 10.1007/s11606-017-4244-2

DO - 10.1007/s11606-017-4244-2

M3 - Article

AN - SCOPUS:85040013959

SP - 1

EP - 10

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

ER -