Enhanced Pain Education for Chronic Pain

(PEPO Trial)

Overseen By Jean Tittley, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Laval University

Must not be taking: Corticosteroids

Disqualifiers: Rheumatoid, Inflammatory, Neurodegenerative, Fibromyalgia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 5

Duration: 10 weeks

86 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to evaluate how different delivery methods of a pain self-management program can assist individuals with chronic musculoskeletal pain. Participants will either complete an online program independently or with additional support from a physiotherapist and group sessions. Researchers believe both methods can reduce pain, but adding support will be more effective. Individuals with musculoskeletal pain lasting more than three months are suitable candidates for this study. As an unphased trial, it offers participants the chance to explore innovative pain management strategies that could enhance their quality of life.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

What prior data suggests that these self-management programs are safe for chronic pain patients?

Research has shown that pain self-management programs are generally safe for people with chronic pain. Studies have found that these programs help participants manage their pain better without major risks.

For example, one study examined the results of chronic pain self-management training and found that participants could effectively manage their pain through group talks or one-on-one meetings. This finding suggests that support from a physiotherapist or peers is safe and well-received.

Another study found that online group-based self-management programs provided good support for people with chronic pain, demonstrating that these methods are safe and helpful. Overall, these programs teach people how to manage their pain, and research supports that they do not cause harmful side effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the new approach to managing chronic pain because it offers a fresh take on patient involvement. Unlike standard treatments, which often rely heavily on medication, this program emphasizes self-management with educational support. What sets it apart is the combination of online learning with interactive sessions involving both a physiotherapist and a peer with chronic pain experience. This holistic approach aims to empower patients and potentially enhance their ability to manage pain more effectively, fostering a sense of community and shared understanding that isn't typically part of traditional pain management strategies.

What evidence suggests that this trial's treatments could be effective for chronic pain?

Research has shown that self-management programs can help people with long-term muscle and joint pain. These programs teach patients to actively manage their pain, leading to small to moderate improvements in pain levels and mobility. In this trial, one group of participants will complete an online pain self-management education program independently. Another group will receive additional support, including sessions with a physiotherapist and participation in group activities. Involving a physiotherapist may enhance these programs by providing personalized advice and encouragement, potentially increasing their effectiveness. Early results suggest that including physiotherapist sessions and group activities could further reduce pain and improve movement. Overall, both methods seem promising, but the extra support might offer additional benefits. ^{6 7 8 9 10}

Who Is on the Research Team?

Jean-Sébastien Roy, PhD

Principal Investigator

Laval University

Are You a Good Fit for This Trial?

This trial is for individuals who have been experiencing musculoskeletal pain for over three months. It's not suitable for those unable to commit to a 26-week study, or with conditions like rheumatoid, inflammatory or neurodegenerative diseases, fibromyalgia, complex regional pain syndrome, or recent corticosteroid injections.

Inclusion Criteria

I have had muscle or joint pain for over 3 months.

Exclusion Criteria

I have been diagnosed with a condition like rheumatoid arthritis, fibromyalgia, or similar.

I have had a corticosteroid injection in the last 3 months.

Unable to participate throughout the 26 weeks of the study.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in a 10-week online pain self-management program, with additional support for some participants including two physiotherapist-led sessions and one group session.

10 weeks

3 visits (in-person) for enhanced self-management group

Follow-up

Participants are monitored for changes in pain-related functional limitations and other secondary outcomes at 10 and 26 weeks.

16 weeks

2 evaluation sessions (virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Additional support for self-management program
• Pain self-management program

Trial Overview The PEPO Trial is testing a 10-week online self-management program for chronic pain. One group will follow the program independently while another will receive extra support including two sessions led by physiotherapists and one group session.

How Is the Trial Designed?

Group I: Pain self-management with support from a physiotherapist Experimental Treatment 2 Interventions

Participants will complete an online pain self-management education program, and, during the treatment period, will take part in two sessions with a physiotherapist and one group session led by a peer living with chronic MSKP.

Group II: Pain self-management Active Control 1 Intervention

Participants will complete an online pain self-management education program by themselves as it is intended.

Who Is Running the Clinical Trial?

Laval University

Lead Sponsor

Trials

439

Recruited

178,000+

Quebec Pain Research Network

Collaborator

Trials

6

Recruited

10,700+

Published Research Related to This Trial

The Chronic Pain Self-Management Programme (CPSMP) was found to be feasible and well-received by participants, with over 75% recommending it to others, indicating its potential for broader implementation.

Participants in the CPSMP experienced significant and stable improvements in pain, disability, and psychological factors like anxiety and depression over a 5-month follow-up, although the overall changes were modest.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A prospective evaluation of the Chronic Pain Self-Management Programme in a Danish population of chronic pain patients. Mehlsen, M., Heegaard, L., Frostholm, L.[2022]

A systematic review of nine studies on educational interventions for chronic pain found that education alone does not significantly reduce pain or disability in adults, with pooled data showing no improvement compared to usual care.

The only positive outcome was observed with pain neurophysiology education (PNE), which showed a decrease in disability and improved knowledge about pain, but the evidence is not strong enough to recommend PNE as a standalone treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of education to facilitate knowledge about chronic pain for adults: a systematic review with meta-analysis. Geneen, LJ., Martin, DJ., Adams, N., et al.[2022]

A pilot study involving 152 military health system beneficiaries demonstrated that an app-based pain education program was feasible and well-received, with 73% of participants finding the videos helpful.

The study suggests that providing tablet-based pain management education in various clinic settings, not just specialty pain clinics, can enhance patient understanding and discussions about pain management and opioid safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

App-Based Pain Management and Opioid Education Program for Patients in Clinic Waiting Rooms. Highland, KB., Giordano, NA., Kirk, K., et al.[2021]

The Cancer Pain Education for Patients and the Public (CPEPP) project aims to enhance pain management by providing essential education to patients and the public about cancer-related pain.

The CPEPP curriculum offers resources and support to ensure effective implementation of pain education, highlighting its importance in improving overall pain management strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cancer pain education for patients and the public. Ferrell, BR., Juarez, G.[2019]

An 11-minute educational movie on chronic pain significantly increased pain knowledge among 95 adolescent students, with a notable effect size indicating strong effectiveness (ηp2 = 0.544).

Students who reported frequent pain (at least once a week) showed a greater increase in knowledge about managing chronic pain compared to those without frequent pain, suggesting targeted educational interventions may be particularly beneficial for this group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of a short educational movie on promoting chronic pain health literacy in school: A feasibility study. Wager, J., Stahlschmidt, L., Heuer, F., et al.[2019]

A 12-week 'Pain Education School' for 102 veterans significantly improved their pain beliefs, readiness for self-management, and reduced depressive symptoms, indicating the program's effectiveness in managing chronic pain.

Veterans who participated in the program using an audience response system (ARS) showed greater increases in pain knowledge compared to those who did not use ARS, highlighting the benefits of active learning in pain education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Audience Response Systems to Enhance Chronic, Noncancer Pain Knowledge Acquisition Among Veterans. Simmons, EB., Cosio, D., Lin, EH.[2022]

In a study of 55 adults with chronic pain, those with higher education levels showed a greater improvement in pain biology knowledge after a 2-hour pain education session, with an average increase of nearly 2 points on the Neurophysiology of Pain Questionnaire (rNPQ).

Age was also a factor, as older participants (10 years older) had a smaller increase in rNPQ scores, suggesting that education level is a more significant predictor of knowledge gain from pain education than other clinical factors like pain severity or mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Which Patients With Chronic Pain Are More Likely to Improve Pain Biology Knowledge Following Education? Pate, JW., Veage, S., Lee, S., et al.[2019]

A randomized controlled trial involving 215 veterans with chronic musculoskeletal pain tested a peer coach-delivered pain self-management program, but adherence to the program was low, with only 13% of patients attending the recommended number of meetings.

Both the peer support and control groups showed a decrease in total pain over 9 months, but there was no significant difference in pain reduction or other secondary outcomes between the two groups, suggesting that the peer support model may need to be revised for better effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial. Matthias, MS., Bair, MJ., Ofner, S., et al.[2021]

A study involving 219 veterans over 12 weeks showed high satisfaction with the 'Pain Education School' program, with participants reporting that the information was new, useful, and easy to understand.

Participants felt empowered to use the information learned in the program and were likely to recommend it to others, indicating its effectiveness in educating patients about managing chronic pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mixed-method approach to veteran satisfaction with pain education. Watson, EC., Cosio, D., Lin, EH.[2014]

A psychoeducational group program for 88 chronic pain patients led to significant improvements in mental health and pain management, including reduced depression and pain severity after 16 sessions.

At a 1-year follow-up, participants showed continued benefits such as increased return to work, lower healthcare visits, and reduced reliance on pain medication compared to a control group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychotherapy with the chronic pain patient using coping skills development: outcome study. Cole, JD.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6175326/

The effectiveness of generic self‐management interventions ... These results indicate that generic self‐management interventions have a marginal benefit for patients with chronic musculoskeletal pain in the short‐term for ...

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/27656730/

Improving the self-management of chronic pain Our overarching research question was 'Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?'. Aim ...

3. jospt.org jospt.org/doi/10.2519/josptopen.2024.0070

Optimization of a Self-management Program for Chronic ... The primary objective is to compare two modes of delivering an 8-week self-management program for chronic musculoskeletal (MSK) pain.

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0738399111001339

Self-management programs for chronic musculoskeletal ... For arthritis, the findings of this study showed that self-management programs have small to moderate effects in improving pain and disability at the long-term ...

5. bmcmusculoskeletdisord.biomedcentral.com bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06452-4

Supported self-management for all with musculoskeletal pain The aim of this study was to develop a model for inclusive supported self-management intervention(s) for MSK pain that take account of health literacy.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5910333/

Randomized Trial of Chronic Pain Self-Management ... This study evaluates outcomes of delivering chronic pain self-management training with group lectures in a community setting or individual meetings in a clinic ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10210462/

Chronic pain self-management interventions in primary care This study shows that chronic pain self-management interventions consisting of components that learn the participants about chronic pain and include physical ...

8. clinicaltrials.gov clinicaltrials.gov/study/NCT03119896

Supporting Self-management of Chronic Pain Other outcome measures include engagement with the intervention, perceived participation in decision making, consultations and relational satisfaction and ...

9. oregon.gov oregon.gov/oha/HPA/DSI-HERC/EvidenceBasedReports/MSI-SMPs-pubcomment2023.pdf

SELF-MANAGEMENT PROGRAMS FOR CHRONIC PAIN Three studies (N = 1,098) evaluating medication use reported outcomes related to opioid or benzodiazepine medication use by military veterans ...

10. ncoa.org ncoa.org/article/evidence-based-program-chronic-pain-self-management-program-cpsmp-online-synchronous/

Evidence-Based Program: Chronic Pain Self-Management ... Provide support for people with chronic pain in your community through an online group-based self-management program.