INSTITUTE of MUSCULOSKELETAL HEALTH and ARTHRITIS IMHA

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• INSTITUTE of MUSCULOSKELETAL HEALTH and ARTHRITIS
  (IMHA)

KNOWLEDGE EXCHANGE TASK FORCE (KETF)
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Key Points Summary ofChronic Pain
Self-Management Results of Two Research Studies

• Sandra M. LeFort, RN, PhD Judith Watt-Watson,
  RN, PhD Karen Webber, RN, MN Denise Guerriere,
  RN, PhD Peter Coyte, PhD Ruth Croxford, MSc
• Director, School of Nursing
• Memorial University of Newfoundland
• St. John's, NF

A knowledge translation based upon a presentation
made to KETF, November 05, 2004 Ottawa, Ontario.
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Chronic Pain

• Twenty percent of the adult population suffers
  from chronic pain.
• Chronic pain causes severe stress and upset to
  individuals and their families.
• Chronic pain changes the way people work and live
  on a day-to-day basis.
• The estimated cost to the Canadian economy is 10
  billion per year.

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Pain Services Are Limited by

• The way referrals are made to health providers
  persons most disabled are referred first.
• Where you live services are better if you live
  in a city.
• There are not enough health providers trained to
  understand chronic pain and to provide patients
  with effective pain management.
• Pain services cost too much and the health care
  system cannot afford them.

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Old and New Approaches

• In the old days the patient was often seen as a
  victim of pain and turned to the doctor for
  medications to help.
• In many cases, this approach did not work very
  well.
• Today, a new trend in health care provides the
  patient with the information and support he or
  she needs to take a more active role in his or
  her health care.

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Today . . .

• The individual is encouraged to take control over
  his or her pain and its management.
• Patients continue to work closely with the health
  care team.
• Programs, like the ones presented today, are
  being developed to help people to do this.

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We Need New Better Pain Programs . . .

• That are low-cost.
• That are available to people who need them in
  their own communities.
• That help people to better manage chronic pain
  and to improve their quality of life.

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Features of These Programs . . .

• Programs take place in the communities where
  patients see their health care providers.
• Program leaders are clinicians and patient peers
  (other people who have chronic pain).
• Programs that are flexible for different people.
• Based on concerns identified by past program
  participants.
• Programs use a self-management approach to
  patient education teaching people to help
  themselves and to work with their health care
  team to better manage their own health.

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Self Management Programs . . .

• Instill greater patient confidence in their
  ability to make life-improving changes (called
  self-efficacy).
• Increase self-efficacy and resourcefulness
  (problem solving and learning to think
  differently) to improve the persons quality of
  life.
• Often offered in a group setting of 6 to 10
  participants.

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The Chronic Pain Management Program (CPSMP)

• The CPSMP was adapted (with permission) from the
  Arthritis Self Management Program (ASMP)
  developed by Dr. Kate Lorig and now offered by
  Arthritis Societies around the world (including
  in Canada).

• The CPSMP was developed to provide a new program
  addressing chronic pain from many causes (not
  just from arthritis fibromyalgia).
• This way, a wider group of people can be helped.

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The CPSMP

• A standardized program all courses are taught
  in the same way.
• Based in the communities where persons with
  chronic pain live.
• Uses educational coping strategies to increase
  self-efficacy and resourcefulness.
• Gives people ways to manage their pain and health
  and to improve their quality of life
  (self-management).
• Runs for 2 hours per week for 6 weeks.

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The First Study

• Asked if the program did what it was supposed to
  do did the program work?
• Measurements included resourcefulness,
  self-efficacy, problem solving and life
  satisfaction.
• Funded by the National Health Research and
  Development Program (NHRDP) 1995-1997.
• Done in St. Johns Newfoundland, involving 110
  people.
• LeFort, S. et al. (1998). A randomized controlled
  trial of a community-based psycho-education
  program for the self-management of chronic pain.
  Pain. 74 297-306.
• LeFort, S. (2000). A test of Bradens Self-Help
  Model in Adults with chronic pain. Journal of
  Nursing Scholarship, 32(2), 153-160.

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What Were the Results?

• Participants scored significantly better on the
  tests compared to people who did not participate
  in the program.

• Improvements went from 9 to 47 with most people
  somewhere in the middle.
• Results are similar to other studies done looking
  at the Arthritis Self Management Program and
  other similar self-management programs.
• The results support the idea that we should use a
  self-management, educational program (i.e., use
  things like confidence building and problem
  solving skills) in addition to standard therapies.

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The Second Study

• Done from 2000 to 2003 and paid for by the
  Canadian Institutes of Health Research.
• This larger study involved more people (287) and
  was done in different places
• 3 programs in Newfoundland (St. Johns, Gander,
  Corner Brook), 2 in Toronto, 1 in Hamilton and 1
  in Regina.

• More testing was done in this study to look for
  changes in people and to keep track of the
  economic costs.

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What Chronic Pain Means to Me

• We listened to audio-tapes from sessions 1 and 6.
  
• We looked for any common ideas expressed by
  program participants to show what their pain
  meant to them.

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Session 1 Major Themes

• People felt isolation.
• Things were always pretty much the same.
• People talked about their limitations.
• People felt loss.
• People reported a lot of adversity.

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Session 6 Major Themes

• Emphasis on learning from others and helping each
  other.
• People felt their pain was real (validation).
• People were coming to terms with their pain.
• Self-esteem and enjoyment were important.
• Knowledge self-knowledge were common themes.
• People had a sense of hope and direction.
• People were learning to manage.

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Conclusions Based on Both Studies

• Results suggest that generalist health care
  providers, such as community-based nurses, can
  effectively teach the Chronic Pain
  Self-Management Program (CPSMP).
• People taking the CPSMP program showed some small
  but positive changes 3 months after taking the
  course that were still there a year later.
• The CPSMP reduced the indirect costs of chronic
  pain for men.
• Results continue to support the idea of using
  self-management educational approaches to help
  manage chronic pain.

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Acknowledgements

• The CIHR - Institute of Musculoskeletal Health
  and Arthritis wishes to thank
• Dr. Sandra LeFort for allowing the use of her
  material and for the help given to the IMHA -
  Knowledge Exchange Task Force to translate it.
• Members of the Knowledge Exchange Task Force
  Mary Brachaniec, Bill Tillier, Pam Sherwin, Otto
  Kamensek, Blair Boudreau, and Phil Hughes for
  their collaborative effort on this knowledge
  exchange project.
• The views expressed in this presentation are
  those of the Author and are provided for
  information purposes only.