A qualitative study published in Pain Medicine identified factors underlying participation in the Living Better Beyond Pain (LBBP), a self-management training program for patients with chronic pain, as well as benefits gained from participating in the program and barriers to participation.
Study participants (n=58) who completed the program; age, 35 to 70; primarily Hispanic and low-income) with chronic low back or lower extremity pain for >3 months were recruited from 2 primary care practices and an HIV clinic. Patients enrolled in the trial had been treated with opioid analgesics for ≥2 months in the past year. Of the 58 participants who completed the LBBP program, 20 were randomly selected to attend 2 focus groups (10 participants in each) during which they were trained in 8 LBBP topics and were evaluated at a 6-month follow-up. The investigators also performed telephone interviews with 17 patients who discontinued attendance in the focus groups.
According to the qualitative analysis of the discussions during each focus group, themes consistently associated with attitudes that improved LPPB program participation included: belief that only medications were inadequate for managing pain; desire to learn more regarding improved pain management and to reduce pain medications; and frustration with disability. Meeting other individuals with chronic pain and getting support from LBBP team members were also associated with improved program participation.
Attitudes associated with reduced program participation included believing it difficult to find time to travel to attend the program and being too busy with other priorities to participate. Activities within LPPB programs that were tailored for the disabled were found to promote program participation. Challenges associated with the LPPB program were maintenance of home-related activities, although maintaining such activities was found to be rewarding as it was associated with a need for fewer pain medications and increased daily function.
Limitations of the study include its small sample size and the collection of data from a single point in time.
“Our study emphasizes the need to build on the dissatisfaction of patients with chronic pain with their status quo of limited function and social isolation. Further, our participants acknowledged that they previously knew little about how to manage pain in order to reduce reliance on drugs that were not appreciably helping them,” concluded the study authors. “This study offers support for self-management training as an essential component of primary care for chronic pain.”
Turner BJ, Rodriguez N, Bobadilla R, Hernandez AE, Yin Z. Chronic pain self-management program for low-income patients: Themes from a qualitative inquiry [published online October 11, 2018]. Pain Med. doi:10.1093/pm/pny192