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Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial

Published:January 28, 2020DOI:https://doi.org/10.1016/j.apmr.2019.12.016

      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)
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