A prospective evaluation of the Chronic Pain Self-Management Programme in a Danish population of chronic pain patients

doi:10.1016/j.pec.2015.01.008

Patient Education and Counseling

Volume 98, Issue 5, May 2015, Pages 677-680

https://doi.org/10.1016/j.pec.2015.01.008 Get rights and content

Highlights

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We test the feasibility of a Danish version of the patient education course: Chronic Pain Self-Management Programme.
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Chronic pain patients are satisfied with the CPSMP.
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Significant positive changes in pain, disability, catastrophizing, depression, anxiety, and health worry.
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Changes are stable during follow-up.
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Modest scope of changes.

Abstract

Objective

This study evaluates the feasibility and changes in pain, pain cognition, and distress during a patient education course and a 5-month follow-up period. The Chronic Pain Self-Management Programme (CPSMP) is a lay-led patient education consisting of six manualized sessions.

Methods

A Danish adaptation of the CPSMP was tested in four municipalities. The sample consisted of 74 women and 13 men between 26 and 80 years with a long pain history (+10 years). Participants completed questionnaires before the CPSMP, immediately after and 5 months after the program.

Results

The study showed that the Danish version of the CPSMP was feasible. The sample was heterogeneous with respect to age, education, duration and causes of pain but all participants reported serious pain and most experienced high levels of distress and disability. Participants evaluated the CPSMP as satisfying and more than 75% would recommend the program to other patients. Participants showed significant improvements on pain, disability, catastrophizing, depression, anxiety, and health worry, and changes were stable through the follow-up period.

Conclusion

A consistent pattern of stable improvements in pain, pain cognition and distress was observed but the scope of changes was modest.

Practice implications

The Danish version of the CPSMP is feasible.

Section snippets

Background

Chronic pain is pain which persists beyond normal tissue healing time, which is defined as 3 months [1]. The estimated prevalence of chronic pain in the European Union is 27% [2] with human costs such as a reduced quality of life [3], and an increased risk of developing common mental disorders [4]. Waiting lists for specialized pain clinics are often long with deterioration in health as an unacceptable consequence [5]. Therefore, low cost interventions have great individual and societal

Recruitment

Data for the present study was obtained from a pilot test in four municipalities of the adapted Danish version of the Chronic Pain Self-Management Program. Participants were eligible if they were 18+ years, spoke Danish, had pain lasting more than 3 months, rated their pain intensity >5 on a 10-point scale. Pain should not be caused by conditions of primary concern to the participant, e.g. cancer in acute stage or pregnancy, and participants with substance abuse, psychiatric or physical disease

Sample

One-hundred eligible citizens were included in the program. Of these, 87 answered the baseline questionnaire, 69 returned the first follow-up questionnaire immediately after the course and 73 the second follow-up questionnaire. The participants were 26 to 80 years old, had suffered from chronic pain between 0 and 45 years. More than one cause of pain was reported by 48% and 5% marked 4–5 causes of pain. The most frequent causes of pain were tear/work injury, diseases, and accidents, 16%

Discussion

In this prospective but uncontrolled study of the Danish CPSMP, we found significant reductions in pain, physical disability, pain catastrophizing, symptoms of depression and anxiety, and illness worry 5 months after participation in the program. Effect sizes ranged from medium (Cohen's d: 0.50–0.77) for physical symptoms, self-efficacy, and illness worry to large (Cohen's d: 0.89–1.51) for pain catastrophizing, physical disability, depression, and anxiety.

Surprisingly we found a decrease in

Acknowledgement

The study was funded by Trygfonden, Denmark.

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Details of study selection are shown in Fig. 1. Thirty eligible studies were included in the review [51–82]. Authors of a further 46 potentially eligible studies were contacted for additional data; authors of 15 studies were unable to provide additional data, and authors of 31 did not respond.
Depression is common in people with long term conditions, and is associated with worse medical outcomes. Previous research shows perseverative negative thinking (e.g. worry, rumination) predicts subsequent depression and worse medical outcomes, suggesting interventions targeting perseverative negative thinking could improve depression and medical outcomes. Previous studies recruited healthy individuals, however. This review aimed to determine the temporal relationship and strength of prospective association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions.
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A scoping review of the literature on benefits and challenges of participating in patient education programs aimed at promoting self-management for people living with chronic illness
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In addition, one study was conducted in the following countries: Argentina, Canada, Denmark, the Netherlands, Sweden and Turkey. Of the 47 research-based studies, 12 used qualitative methods [26–37], 28 used quantitative methods with randomized controlled design [38–51] or descriptive design [52–65], and seven studies used mixed methods [66–72]. Quantitative approaches relied heavily on questionnaires or surveys that evaluated physical-, social- and psychological domains, knowledge of conditions and treatments, self-efficacy, self-management behaviors, coping and empowerment.
To give a comprehensive overview of benefits and challenges from participating in group based patient education programs that are carried out by health care professionals and lay participants, aimed at promoting self-management for people living with chronic illness.
We searched 8 literature databases. Full text articles meeting the inclusion criteria were retrieved and reviewed. Arksey and O’Malley’s framework for scoping studies guided the review process and thematic analysis was undertaken to synthesize extracted data.
Of the 5935 titles identified, 47 articles were included in this review. The participants experienced the programs as beneficial according to less symptom distress and greater awareness of their own health, improved self-management strategies, peer support, learning and hope.
A substantial evidence base supports the conclusion that group based self-management patient education programs in different ways have been experienced as beneficial, but more research is needed.
The insights gained from this review can enable researchers, health care professionals, and participants to understand the complexity in evaluating self-management patient education programs, and constitute a basis for a more standardized and systematic evaluation. The results may also encourage health care professionals in planning and carrying out programs in cooperation with lay participants.
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Short CommunicationA prospective evaluation of the Chronic Pain Self-Management Programme in a Danish population of chronic pain patients

Highlights

Abstract

Objective

Methods

Results

Conclusion

Practice implications

Section snippets

Background

Recruitment

Sample

Discussion

Acknowledgement

J Pain

Pain

Pain

Pain

Pain

Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy

Pain

Chronic diseases in the European Union: the prevalence and health cost implications of chronic pain

J Pain Palliat Care Pharmacother

The societal burden of pain in Germany: health-related quality-of-life, health status and direct medical costs

J Med Econ

Arthritis self-management studies—a 12-year review

Health Educ Q

Short Communication
A prospective evaluation of the Chronic Pain Self-Management Programme in a Danish population of chronic pain patients