Abstract
Objective
To investigate the effectiveness of chronic pain self-management support with pain
science education and exercise (COMMENCE) on improving function, pain interference,
work status, pain intensity, fatigue, psychological factors associated with pain,
health care visits, satisfaction, and perceived change compared with usual care.
Design
Parallel group randomized controlled trial with 1- and 12-week follow-ups.
Setting
Community health center.
Participants
Adults (N=102) with chronic noncancer pain referred for self-management support. Eighty
of 102 participants completed 12-week follow-up assessments. No participants withdrew
with adverse events.
Interventions
Participants were randomized to COMMENCE or usual care.
Main Outcome Measures
Primary: Function measured using the Short Musculoskeletal Function Assessment–Dysfunction
Index. Secondary: Short Musculoskeletal Function Assessment–Bother Index, Patient
Reported Outcomes Measurement Information System pain interference, work status, numeric
pain, and fatigue rating scales, Tampa Scale of Kinesiophobia, Pain Catastrophizing
Scale, Pain Self-Efficacy Scale, Neurophysiology of Pain Questionnaire, number of
health care visits, satisfaction, and global rating of change.
Results
COMMENCE resulted in greater improvements in function (mean difference [MD] at 12-wk
follow-up=−8.0; 95% CI, −14.7 to −1.3), bother with functional difficulties (MD, −12.0;
95% CI, −20.8 to −3.2), pain intensity (MD, −1.0; 95% CI, −2.1 to −0.1), catastrophizing
(MD , −8.2; 95% CI, −14.5 to −2.0), self-efficacy (MD, 7.0; 95% CI, 0.8-13.2), knowledge
(MD, 2.8; 95% CI, 1.6-3.9), satisfaction (MD, 1.2; 95% CI, 0.7-1.8), and perceived
change (MD, 1.4; 95% CI, 0.8-2.1). There were no significant between-group differences
in pain interference, work, fatigue, depressive symptoms, or health care visits.
Conclusion
COMMENCE is more effective than usual care at improving function, pain, catastrophic
thinking, self-efficacy, pain knowledge, satisfaction, and perceived change but not
pain interference, work status, fatigue, depressive symptoms, or health care visits.
Keywords
List of abbreviations:
COMMENCE (chronic pain self-management support with pain science education and exercise), MD (mean difference), PT (physiotherapist), RCT (randomized controlled trial), SMS (self-management support), WACHC (Woodstock and Area Community Health Center)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: January 28, 2020
Footnotes
Current affiliation for Miller, School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada. Current affiliation for MacDermid, School of Physical Therapy, Western University, London, Ontario, Canada.
Jordan Miller was funded by an Ontario Graduate Scholarship and the School of Rehabilitation Science at McMaster University . Joy MacDermid was funded by a Canadian Institute for Health Research chair in Gender, Work, and Health and Dr James Roth Chair in Musculoskeletal Measurement and Knowledge Translation.
Clinical Trial Registration No.: NCT02422459.
Disclosures: Dr Walton is the owner/operator of a small personal business that provides continuing professional development services for clinicians. He provides evidence-based recommendations for management of chronic pain, and as such it is possible that the results of this study could be used in that teaching. Because he would be providing such education regardless of the existence of this article, this does not represent a conflict of interest. The other authors have nothing to disclose.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
