JMIR Publications

ABSTRACT

Background:

Patients with chronic pain on long-term opioid therapy often face barriers to accessing effective non-pharmacological treatments, including the burden of multiple sessions, lack of trained clinicians, and travel time. Empowered Relief (ER), a two-hour, single-session pain relief skills class can improve pain and quality of life among patients with chronic pain when delivered in-person or virtually.

Objective:

This study examines the impact of Zoom-delivered ER among people with chronic pain on long-term opioid therapy. We assessed: 1) the feasibility and acceptability of Zoom-delivered ER, 2) changes in pain and opioid use outcomes at 3 and 6-months post-treatment, and 3) daily associations between pain, opioid dose, and pain catastrophizing (PCS) pre- and post-treatment.

Methods:

During the early COVID-19 pandemic, we conducted an uncontrolled pilot of Zoom-delivered ER among 60 adults (76% female, 88% white) experiencing chronic pain who were receiving daily prescribed opioids (≥ 10 morphine-equivalent daily dose). Participants completed assessments at enrollment, pre-class, post-class, 3-months post-treatment, and 6-months post-treatment. Participants also completed two daily assessment periods (spanning 14 consecutive days) before and after the class. We used a multilevel modeling approach to examine 1) raw changes in PCS, average pain intensity, pain interference, and self-reported opioid dose at 3 and 6-months post treatment, and 2) daily-level changes in average pain intensity and opioid dose before and after the class.

Results:

Of the 60 participants enrolled, 41 (68%) attended the class and 24 (59% of class attendees) reported satisfaction with the Zoom-delivered class. PCS was significantly reduced at 3-months (b = -3.49, p = .010; d = .35) and 6-months post-treatment (b = -3.61, p = .010; d = .37), and pain intensity was significantly reduced at 3-months (b = -.56, p = .010; d = .39) compared to enrollment. There were no significant reductions in pain interference or opioid dose. Across daily assessments, higher daily pain catastrophizing was associated with worse daily pain (b = .42, p < .001) and higher self-reported opioid use (b = 3.14, p < .001); and daily pain intensity significantly reduced post-class (b = -.50, p < .001). People taking prescribed opioids as needed (PRN) trended towards decreasing their daily opioid use after the class (b = -9.31, p = .02) though this result did not survive correction for multiplicity.

Conclusions:

Zoom-delivered ER is feasible, acceptable, and shows preliminary evidence of reducing PCS and daily pain intensity. A larger randomized controlled trial of Zoom-delivered ER among this patient population is currently underway.