September 7, 2021
3 minute reading
Disclosure: Darnall reports personal expenses as Chief Scientific Advisor of AppliedVR; royalties for pain treatment books; research awards from the Patient-Centered Outcomes Institute (PCORI); consulting fees from Axial Healthcare; board members of the American Academy of Pain Medicine and the Institute of Brain Potential ; He is a scientific member of the NIH Interagency Pain Research Coordinating Committee, the Centers for Disease Control and Prevention Opioid Task Force, and the American Psychological Association Pain Advisory Group; and is the principal investigator of another NIH Research Award. Please refer to the research for the relevant financial disclosures of all other authors.
The data shows that a single class on pain management skills is not inferior to 8-week cognitive behavioral therapy, and is better than health education classes, which is a pain disaster for 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 condition,” Dr. Beth D. Darnall Stanford University School of Medicine professor said Healio Rheumatology“For many patients, access to non-pharmacological pain care is still limited. Even if it is accessible, a multi-session therapy format is not feasible or unnecessary for patients. Effective and easy-to-use solutions are needed to ensure Fair access to effective pain care.”
write on JAMA Internet Open, Darnall and colleagues described how they developed a single-session, 2-hour course called “Empower Relief” to quickly enable individuals to master pain self-management skills. According to the researchers, the program “combines pain education, self-regulation skills (i.e. relaxation, cognitive reconstruction, and self-comfort) and the principles of mindfulness.”
However, they write that the comparison of authorized relief and cognitive behavioral therapy has not yet been tested in randomized clinical trials, and the durability and scope of the effects of the treatment are unclear. To examine the comparison of the single-category authorized mitigation plan with eight cognitive behavioral treatment strategies or health education in terms of pain catastrophe, intensity and interference, and other outcomes, Darnall and colleagues conducted a randomized clinical trial.
Beth D. Danal
Participants were recruited from an academic center in the San Francisco Bay Area. The inclusion criteria are that at least half a day has experienced axial low back pain in the past 6 months, with an average pain intensity score of at least 4 from 0 to 10, fluent in English, aged 18 to 70 years, at least 20 points on the Pain Catastrophic Scale, and able to Take up to 8 2-hour courses.
Exclude individuals with severe cognitive impairment, nerve root symptoms, intensive remission or cognitive behavioral therapy in the past 3 years, current substance use disorder, forensic factors, suicidal ideation, or severe depression.
A total of 263 participants were randomly divided into three groups, of which 87 participated in the empowerment relief program, 88 received 8 cognitive behavioral treatments, and 88 received health education. From May 24, 2017 to March 3, 2020, collect participant self-reported data at baseline, before treatment, and 1, 2, and 3 months after treatment. The main result is that the pain intensity and interference are set as the priority secondary results after 3 months of treatment with the difference between the pain catastrophe scale scores.
According to the researchers, the pain catastrophic score at 3 months of authorized relief is not inferior to cognitive behavioral therapy (difference = 1.39; 97.5% CI, – to 4.24). At the same time, authorized 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) are both superior in terms of pain catastrophe score health education.
“We also found that a single pain session has a wide range of effects, including pain intensity, pain interference, pain-related pain, anxiety, depression, sleep disturbances, and fatigue within 3 months, which are significantly reduced,” Danal said Healio Rheumatology.
The reduction in pain catastrophic scores (–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 are clinically significant. The health education score decreased to –4.6 (95% CI, –7.18 to –2.01).
The researchers adjusted the baseline pain catastrophic score between groups and used an intention-to-treat analysis. In this analysis, for pain intensity and pain interference, as well as sleep disorders, pain distress, painful behaviors, depression and anxiety, authorized relief is not inferior to cognitive behavioral therapy. However, authorized relief programs are not as good as cognitive behavioral therapy in terms of physical function.
“Our research provides evidence that a single pain relief skill course—Empowered Relief—may be an efficient way for some patients to obtain meaningful relief,” Darnall said. “We need to enable people with persistent pain to obtain information and skills as early as possible to help them best manage pain and related symptoms. Our current model of providing behavioral pain treatment is to provide it later — or not at all — to make it painful. The difference between pain care and pain care has long existed. Our findings point to a promising solution.”
She later added: “We hope to conduct a national comparative effectiveness study of Empower Relief in 2022 and test its integration with the primary care environment.”