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Virtual Self-Management Has Potential Benefits and Challenges: A Response to a Letter to the Editor

Published:September 18, 2020DOI:https://doi.org/10.1016/j.apmr.2020.07.010
      We thank Drs Silver and Yih for their interest in our trial, “Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial,”
      • Miller J.
      • MacDermid J.C.
      • Walton D.M.
      • Richardson J.
      Chronic pain self-management support with pain science education and exercise (COMMENCE) for people with chronic pain and multiple comorbidities: a randomized controlled trial.
      and for their shared recognition of the importance of identifying effective self-management supports for people living with pain who experience multimorbidity and barriers to accessing health care.
      We fully agree with the authors’ suggestion that digital self-management supports provide an important opportunity to overcome geographic and transportation barriers to participation that are common for people living with pain.
      • Blair M.J.
      • Matthias M.S.
      • Nyland K.A.
      • et al.
      Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression.
      ,
      • Austrian J.S.
      • Kerns R.D.
      • Carrington R.M.
      Perceived barriers to trying self-management approaches for chronic pain in older persons.
      Incorporating the unique elements of COMMENCE, such as tailored of exercises and cognitive-behavioral approaches, in a digital self-management support may pose additional challenges in comparison with more standardized self-management supports. However, we agree that this is a worthy pursuit and suggest that research on the feasibility, barriers, and facilitators of incorporating these elements within online self-management programs is an important next step. We have begun to incorporate some of these elements in digital self-management supports (www.iamable.ca) and look forward to contributing to a growing body of literature evaluating digital self-management supports by evaluating a digital self-management support that incorporates some of the unique aspects of COMMENCE in the near future. We hope other readers may join this call to action.
      We would also like to share a potential challenge with offering digital self-management supports. The context created by the coronavirus disease 2019 pandemic has led to a rapid shift to delivering care virtually, including attempts to deliver COMMENCE online. We are hearing from our clinical community about some of the successes and challenges associated with this shift. Certainly, we have heard examples of how virtual interventions have helped overcome transportation barriers and reduced the risk of transmission of coronavirus disease 2019. However, we are also hearing concerns that offering digital self-management, rather than in-person self-management, may be further contributing to inequities in care for people who lack the technical skills to access digital platforms, people who have lower health literacy, and people without adequate financial resources to afford a computer or smart phone. As we continue along the path toward effective digital chronic pain self-management supports to increase the reach of these interventions, we need to identify strategies to address the multiple barriers that contribute to inequitable access, so we do not end up exacerbating other inequities in access to care while we address geographic and transportation barriers.
      Thank you again to Drs Silver and Yih for the thoughtful letter and to the editor for the opportunity to contribute to this important conversation.

      References

        • Miller J.
        • MacDermid J.C.
        • Walton D.M.
        • Richardson J.
        Chronic pain self-management support with pain science education and exercise (COMMENCE) for people with chronic pain and multiple comorbidities: a randomized controlled trial.
        Arch Phys Med Rehabil. 2020; 101: 750-761
        • Blair M.J.
        • Matthias M.S.
        • Nyland K.A.
        • et al.
        Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression.
        Pain Med. 2009; 10: 1280-1290
        • Austrian J.S.
        • Kerns R.D.
        • Carrington R.M.
        Perceived barriers to trying self-management approaches for chronic pain in older persons.
        J Am Geriatr Soc. 2005; 53: 856-861