Five‐year Observational Study of Internet‐Delivered Cognitive Behavioural Pain Management when offered as Routine Care by an Online Therapy Clinic

Objective: To present the theoretical foundation and methodological considerations for a group-based pain management programme for patients with persistent non-specific low back pain and psychosocial risk factors. Method: The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework for describing the content, structure and context of the program. The theoretical rationale underlying the pain management programme was described using the first three steps of the Intervention Mapping framework. The Fear-avoidance model and the Self-efficacy Theory were identified as the two main theories. These were used to establish specific factors addressed by the pain management programme as well as expected outcomes. Intervention description: A multidisciplinary, group-based programme using a cognitive-behavioural approach was developed. The programme consisting of six sessions of two hours duration, took place at a spine clinic at a regional hospital in Denmark. Psychoeducation and cognitive restructuring were specific strategies hypothesised to induce changes in outcome measures. The outcomes expected to change as a result of the intervention were disability, quality of life, sick leave and physical activity. A pilot study was performed, subsequent adjustments made and the final content and educational materials completed by January 2017. Conclusion: The theoretical foundation and underlying evidence for the hypothesised change mechanisms in the use of a cognitive-behavioural approach was presented. A theoretically sound and practically feasible intervention has been developed and its effectiveness is being determined in a randomised controlled trial, including 130 low back pain patients, which is currently underway.

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Pain Management in Context of Emotionally Unstable Personality Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1843 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S500-S500

Author(s):

E. Dobrzynska ◽

N. Clementi

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Personality Disorder ◽

English Language ◽

Opioid Analgesics ◽

Management Options ◽

Cognitive Behavioural ◽

Keywords Chronic Pain ◽

Competing Interest ◽

Emotionally Unstable Personality Disorder

IntroductionEmotionally unstable personality disorder (EUPD) is characterised by Pain Paradox. The response for acute, self-induced pain seems to be attenuated while chronic, endogenous pain is usually intolerable. Pain management of this group of patients poses many difficulties, including discrepancies between subjective and objective pain assessment, patients’ demands for strong analgesics and impact on relationship with other professionals.Objectives and aimsThe purpose of the study was to review pain management options for persons diagnosed with EUPD and complaining of chronic pain.MethodsMEDLINE and PsycINFO databases were searched for all English-language articles containing the keywords “chronic pain”, “pain management”, “borderline personality disorder”, and “emotionally unstable personality disorder”.ResultsSeventeen relevant papers were identified. Suggested first step in pain management was ongoing clarification with EUPD patients that analgesics are unlikely to fully treat their pain and support of non-pharmacological approaches to pain, including cognitive-behavioural strategies. Regarding pharmacology, liberal use of non-addicting analgesics was recommended with highly conservative use of opioid analgesics. Importance of evaluation and treatment of any underlying mood and/or anxiety syndromes was stressed as well as liaison with other professionals (e.g. psychologists, neurologists, orthopaedics, and physiotherapists).ConclusionsPatients with EUPD often report chronic pain, which can only be managed by close collaboration of professionals from different disciplines.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Understanding the Users with Chronic Pain on AI CBT Mental Health App (Wysa): A Mixed-Methods Retrospective Observational Study (Preprint)

10.2196/preprints.35671 ◽

2021 ◽

Author(s):

S Meheli ◽

Chaitali Sinha ◽

Madhura Kabada

Keyword(s):

Mental Health ◽

Chronic Pain ◽

Pain Management ◽

Observational Study ◽

Real World ◽

Effect Size ◽

Retrospective Observational Study ◽

Medium Effect ◽

Health Concerns ◽

Perceived Needs

BACKGROUND Digital health interventions can bridge barriers in access to treatment of care for individuals with chronic pain. OBJECTIVE This study aimed to evaluate the perceived needs, engagement and the effectiveness of the mental health app Wysa on mental health outcomes among real-world users who reported chronic pain and engaged with the app for support. METHODS Real-world data from users (N = 2,194) who reported chronic pain and associated health conditions in their conversations with a mental health app was analyzed using a mixed-method retrospective observational study. An inductive thematic analysis was used to analyse conversational data of users with chronic pain to assess perceived needs, along with comparative macro-analyses of conversational flows to capture engagement within the app. Additionally, the scores from a subset of users who completed a set of pre-post assessment questionnaires, namely PHQ-9 (N=69) and GAD-7 (N=57), were examined to evaluate the effectiveness of Wysa in providing support for mental health concerns for those managing chronic pain. RESULTS The themes emerging from the conversations of users with chronic pain included Health Concerns, Socioeconomic Concerns, and Pain Management Concerns. Findings from the quantitative analysis indicated that users with chronic pain showed significantly greater app engagement (p value <2.2e-16) than users without chronic pain, with a large effect size (Vargha and Delaney’s A- 0.76 -0.8). Furthermore, the sample of users with pre-post assessments during the study period were found to have significant improvements in group means on both PHQ-9 and GAD-7 symptom scores, with medium effect size (Cohens’d, 0.6-0.61), respectively. CONCLUSIONS The findings indicate that users look for tools that can help them address their concerns related to mental health, pain management, and sleep issues. The study findings also indicate the breadth of needs for users with chronic pain and the lack of support structures, and suggests that Wysa can provide effective support to bridge the gap.

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Noninterventional Observational Study Using High-Dose Controlled-Release Oxycodone (CR Oxycodone) for Cancer Pain Management in Outpatient Clinics

Pain Medicine ◽

10.1111/pme.12228 ◽

2013 ◽

Vol 14 (12) ◽

pp. 1866-1872 ◽

Cited By ~ 2

Author(s):

Sun Kyung Baek ◽

Hye Won Shin ◽

Young Jin Choi ◽

Dae Young Zang ◽

Do-Yeun Cho ◽

...

Keyword(s):

Pain Management ◽

Controlled Release ◽

Observational Study ◽

Cancer Pain ◽

Outpatient Clinics ◽

High Dose ◽

Cancer Pain Management

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The cognitive-behavioural approach to pain management

Wall and Melzack's Textbook of Pain ◽

10.1016/b0-443-07287-6/50027-8 ◽

2006 ◽

pp. 339-348 ◽

Cited By ~ 11

Author(s):

Dennis C. Turk ◽

Herta Flor

Keyword(s):

Pain Management ◽

Behavioural Approach ◽

Cognitive Behavioural

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Cognitive-behavioural interventions

Oxford Textbook of Paediatric Pain ◽

10.1093/med/9780199642656.003.0050 ◽

2013 ◽

pp. 519-530 ◽

Cited By ~ 1

Author(s):

Deirdre E. Logan ◽

Rachael M. Coakley ◽

Brittany N. Barber Garcia

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Practical Problem ◽

Psychological Treatment ◽

Behavioural Therapy ◽

Behavioural Interventions ◽

Empirically Supported ◽

Cognitive Behavioural ◽

Hands On ◽

Cognitive Behavioural Interventions

Cognitive-behavioural therapy (CBT) is the most commonly researched and empirically supported psychological treatment for the management of paediatric pain. CBT is a brief, goal-oriented psychotherapy treatment using a hands-on, practical problem-solving approach (Kendall, 2012). It is based on the concept that thoughts, feelings, and behaviours are causally interrelated. This chapter offers an overview of CBT and its application to pain management, describes specific cognitive-behavioural strategies commonly used for paediatric acute and chronic pain problems, presents the empirical evidence supporting these approaches, and highlights key considerations and emerging directions in the use of CBT and related treatments for paediatric pain.

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