Background/Purpose: In 2021, 51.6 million (20.9%) US adults reported chronic pain (CP). Arthritis is a leading cause of CP. The Stanford Chronic Pain Self-Management Program (CPSMP) is a 6-week, evidence-based community-delivered workshop that increases participants’ self-efficacy for managing CP in the short term. This study examined the short- (6 mos) and long-term (12 mos) outcomes of CPSMP on pain severity, pain self-efficacy, and pain disability in adults with CP.

Methods: Adults aged ≥ 18 yrs, with pain on most or every day in the past 3 mos, were eligible. After a baseline assessment, participants were randomized to an Immediate Group (IG) or a 6-mo, wait-list Control Group (CG). The IG was offered the CPSMP then underwent 6- (post-CPSMP) and 12-mo (follow-up) assessments. After a 6-mo period as wait-list controls (pre-CPSMP), the DG was offered CPSMP then assessed at 12- (6-mo post-CPSMP) and 18-mos (12-mo post-CPSMP). Arthritis status was identified using a public health case finding question. Outcomes were pain severity (Defense & Veterans Pain Rating Scale), pain self-efficacy (Pain Self-Efficacy Scale), and pain disability (Pain Disability Index). Mixed linear models, adjusted for age, sex, and income, assessed outcomes for 2 study designs: 1) between-group differences from baseline to 6 mos (controlled trial) and 2) longitudinal changes from pre-intervention to follow-up (12 mos) in both groups (uncontrolled).

Results: The study sample were 170 primarily older (mean age ± SD, 65 ± 13 yrs [range, 29-88]) women (74%) who were randomized to the IG (n=89) or CG (n=81). Eight-seven percent reported having arthritis. Mean attendance at the 23 workshops was 3.6 ± 2.5 out of 6 sessions. For the controlled trial analysis, the IG reported a significant reduction in pain disability compared with the CG (difference ± standard error, 4.7 ± 2.2, p=0.04, effect size [ES]=2.1), with no differences in pain severity (-0.02 ± 0.26, p=0.95, ES=-0.06) or pain self-efficacy (-2.3 ± 1.6, p=0.14, ES=-1.5). For the longitudinal analysis, there were significant time and group effects for pain severity with reductions in both the IG and CG over 12 mos (coefficient ± standard error, -0.19 ± 0.07, p< 0.01), and lower scores in the IG than in the CG (0.56 ± 0.25, p=0.03). Pain self-efficacy significantly improved in both groups over 12 mos (1.54 ± 0.41, p< 0.001) while the reduction in pain disability was borderline significant (-0.99 ± 0.52, p=0.06). Age was significant in all models with outcomes improving more in older versus younger participants. For pain self-efficacy and pain disability, outcomes improved as income increased.

Conclusion: In the 6-mo controlled trial, CPSMP produced a large effect for pain disability with no changes in pain severity or pain self-efficacy. In the longitudinal analysis (uncontrolled 12-mo follow-up), pain severity and pain-self-efficacy improved in the entire group. Participants who were older, or had higher income, tended to have better outcomes. Outcomes for men and women were the same. Results from the longitudinal design suggest that CPSMP is an effective intervention but the different results from the controlled trial design illustrate the need for further controlled studies examining the effectiveness of CPSMP.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-the-stanford-university-chronic-pain-self-management-education-program-on-pain-severity-pain-self-efficacy-and-pain-disability-in-a-population-with-a-high-prevalence-of-arthritis/