Background/Purpose: In 2016, 1 in 5 US adults reported chronic pain (CP). Osteoarthritis and rheumatoid arthritis are top causes of CP. The Stanford University Chronic Pain Self-Management Program (CPSMP) is a 6-week, low-cost community-delivered workshop that increases participants’ confidence in self-managing their CP. We describe baseline participation in a randomized, wait-list (6 months) controlled trial on CPSMP’s short- and longer-term outcomes in West Virginia, a population with a high prevalence of arthritis, CP, opioid deaths, and socio-economic deprivation.

Methods: Community-dwelling adults, aged ≥ 18, with CP of ≥ 3 months, were eligible. Ineligibility criteria were cancer, an open wound, planned surgery in next year, or participation in a similar self-management program in the past year. Participants were recruited from clinics and the community via direct mailings, newspaper articles/advertisements, word-of-mouth, social media, and an electronic patient portal. Baseline data collected included age, sex, arthritis status (yes/no), and pain severity (Stanford Pain Visual Numeric Scale [0=no pain, 10=severe pain]), categorized as no (0), low (1-4), moderate (5-6), or severe (7-10) pain. Participation was the number enrolled divided by the number of eligible participants, multiplied by 100. Barriers to enrollment were identified. Descriptive statistics determined the characteristics of those who enrolled in the study. Statistical tests were conducted to determine if pain severity (categories) varied by: 1) age (Spearman’s correlation) or 2) sex and arthritis (Cochran-Mantel-Haenszel tests).

Results: From June 2018 to March 2019, 336 people inquired about the study, 323 (96%) were screened for eligibility, 281 of the 323 (87%) were eligible, and 176 of the 281 enrolled, for a total of 63% participation. Enrollment barriers to participation were: not understanding what CP meant, the stigma associated with having CP, low socioeconomic status, and competing life priorities. At baseline, participants were primarily women (76%); mean age ± SD was 65 ± 13 years (range, 28 to 88). Most participants had arthritis (88%). The mean ± SD, range, and median (interquartile range) pain severity scores were 6.6 ± 1.9, 0-10, and 7.0 (3.0), respectively, with 1% with no pain, 10% mild pain, 39% moderate pain, and 50% with severe pain. Among those with severe pain (n=86), 71% were women and 89% had arthritis. The prevalence of severe pain was lower among older participants (43%, aged ≥ 65) compared to younger ones (61%, aged 18-64) (p=0.006). The distribution of pain severity was similar by sex (p=0.23) or arthritis status (p=0.66).

Conclusion: In a population with multiple challenges, including high arthritis prevalence, participation seemed moderate, possibly due to barriers identified during recruitment. One in 2 trial participants reported severe pain indicating that the recruitment strategy captured individuals in West Virginia with a substantial need for pain management interventions. Because some barriers to trial participation may also be barriers to implementing CPSMP in the community, strategies to increase understanding of CP and reduce its stigma may be important ways to eventually increase CPSMP’s reach.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/participation-in-the-stanford-university-chronic-pain-self-management-program-in-a-population-with-a-high-prevalence-of-arthritis/