Online Health Programs Help Reduce Pain

By Pat Anson, PNN Editor

Online health programs can help patients with chronic pain conditions learn how to manage their pain and other symptoms, according to two new studies. One “e-health” program even helped patients reduce their use of opioids.

Online pain self-management programs have proliferated in recent years due to the pandemic and greater acceptance of telemedicine, but few studies have assessed their effectiveness. The programs provide content similar to what a patient might receive from a pain psychologist — in-person treatment that often is not accessible or affordable for everyone.

In a small study at the University of California, Irvine (UCI), researchers recruited sickle cell patients through advertisements on Facebook, Reddit and other social media sites. Sickle cell disease is a painful genetic disorder that primarily affects people of African or Hispanic descent. Many sickle cell patients face stigma when they seek treatment for pain flares and have learned to distrust the healthcare system.

“Before the study, we were told sickle cell researchers thought online outreach to patients would not work as patients wouldn't trust the process,” said Sean Young, PhD, a professor in UCI’s Departments of Emergency Medicine and Informatics. “Surprisingly, we found it worked really well.”

Researchers recruited 32 young adult patients with sickle cell to watch a 20-minute video that taught mindfulness meditation. Afterward, participants were emailed links to additional audio recordings for ongoing practice. Patients rated their pain intensity, anxiety and depression before and after the mindfulness training.

“Patients with sickle cell disease struggle with pain, and unfortunately, they have few options for relief,” said Young. “We developed and tested a brief online intervention to teach them mindfulness and found that it helped their pain both immediately and for six weeks after they viewed the mindfulness exercise.”

The study findings, recently published in the journal Cureus, show that after six weeks of mindfulness training, pain intensity declined an average of 1.3 points, anxiety decreased by 1.8 points, and depression declined by 1.7 points.

Researchers think younger sickle cell patients feel more comfortable participating in e-health programs. About 97% of participants watched the full mindfulness video and a little over half listened to additional recordings.

Reduced Opioid Use 

The second study of an e-health program, published in the journal Pain, involved over 400 pain patients on long-term opioid treatment who were recruited by researchers at Washington State University. Half the participants watched a pain self-management program and the other half received treatment as usual, serving as a control group.

Patients in the e-health group watched an online course designed by a psychologist, called Goalistics Chronic Pain Management, which aims to help people manage their pain through cognitive behavioral therapy, exercise and relationship advice, as well as information about opioid use and risks.

After six months, over half the patients in the e-health group (53.6%) were able to reduce their opioid dose by 15% or more, compared to 42.3% of patients in the control group.

There was not much change in pain levels in either group. Pain intensity declined by at least two points in only 14.5% of e-health participants, and in 6.8% of the control group.

"These were very encouraging findings: not only were they reducing opioids but also their pain was not becoming worse," said lead author Marian Wilson, PhD, an Associate Professor of Nursing at WSU. "Some people are hesitant to stop their opioid medication because they fear their pain will increase, but we found that at least on average in this population, they could reduce their opioids a bit and not have increased pain symptoms."

Wilson and her colleagues also observed the e-health patients improved their knowledge about pain, confidence in managing it, and their coping skills.

"The idea is to put the patient in the driver's seat because we can give them a prescription for opioids, and that will work for a little while, but over time for chronic pain, it's not usually going to be the solution to fix all their troubles," she said.

The Goalistics e-health program currently has a monthly $30 fee, which usually is not covered by insurance. In addition to pain management, Goalistics also has an online self-management program for depression.