Access to e-health programs may reduce chronic pain, opioid use

A new study has shown that for people with chronic pain taking opioids over the long term, incorporating an internet-based self-management program into treatment may help reduce both pain and opioid intake.

Pain is the most common reason people seek medical attention and is the leading cause of disability, affecting more than 30% of people worldwide. Chronic pain is defined as pain that persists or recurs for longer than three months. Approximately 50 million people in the US have chronic pain, and about 18 million of those are prescribed long-term opioid therapy (LOT).

The problems associated with LOT are well-known and include the risk of abuse and misuse, drug tolerance, physical dependence, respiratory depression, and accidental death. For these reasons, the Centers for Disease Control and Prevention (CDC) recommends that people taper their opioid use and employ alternative methods of managing pain, including education, cognitive behavioral therapy (CBT) and interdisciplinary rehabilitation.

There is a great deal of research supporting the use of self-management programs to improve pain and minimize disability. Internet-based (e-health) programs have been shown to offer an affordable, accessible way for people with chronic pain to access self-management tools, but no studies have assessed their effect on opioid use reduction.

A new study by Washington State University has now examined how e-health programs impacted long-term opioid therapy and chronic pain. About 400 participants who’d been prescribed LOT for pain were divided into two groups, one received treatment as usual, and the other was provided with access to a self-guided e-health program.

The e-health program used, called the Goalistics Chronic Pain Management Program, was developed by pain psychologists. Its content is presented through a combination of on- and offline activities, including videos, symptom-tracking tools, and downloadable worksheets. Additional content includes information on opioid tolerance and dependence, and non-opioid treatment options. Engagement required nothing more than a phone and internet connection.

E-health participants received weekly emails with program instructions and goals for completing weekly activities. Participants completed self-report measurements of opioid use throughout the study and assessed their pain on a 10-point scale. At the start of the study, all participants rated their pain at an average intensity of five or six out of 10, with 10 representing the most extreme pain.

Researchers found that more than half (53.6%) of the participants given access to e-health reduced their opioid intake by 15% or more after six months, compared to 42.3% in the control group.

Significantly, at the study’s conclusion, 14.5% of the e-health group reported that their pain had reduced by two points or more. Only 6.8% of participants in the control group reported the same decrease in pain scores.

“These were very encouraging findings: not only were they reducing opioids, but also their pain was not becoming worse,” said Marian Wilson, the study’s lead author. “Some people are hesitant to stop their opioid medication because they fear their pain will increase, but we found that at least on average in this population, they could reduce their opioids a bit and not have increased pain symptoms.”

Given the subjective nature of pain, the researchers argue, providing a self-management program that allows tracking of pain levels and trying different pain management strategies helps people feel more in control of their condition rather than offering a quick fix.

“The idea is to put the patient in the driver’s seat because we can give them a prescription for opioids, and that will work for a little while, but over time for chronic pain, it’s not usually going to be the solution to fix all their troubles,” Wilson said.

In addition, the researchers say that an e-health program such as the one used in this study addresses issues around mood, social and physical functioning that people with chronic pain often experience.

The study’s findings provide further evidence for the benefits of self-management programs in the setting of chronic pain.

Whereas countries like Canada and Australia offer similar e-health programs for free, in the US, access requires payment of a fee that most insurance companies don’t cover. The researchers are currently working on a project aimed at achieving greater access for people in the US.

The study was published in the journal Pain.

Source: Washington State University