A Community-Based Chronic Pain Self-Management Program in West Virginia

Chronic pain (CP) affects 1 in 3 US adults and costs up to $635 billion annually in medical
costs and lost work productivity. The impact of CP is worse in people with both CP and
comorbid chronic diseases such as arthritis, diabetes, and heart disease. Use of opioid
medications for CP has risen in the US, and opioid overdose deaths have quadrupled, yet with
no overall change in pain. Although one-third of US adults have CP, there is a lack of
affordable, non-pharmacological, evidence-based, community-delivered interventions for people
with CP. Thus, there is a vital need to rigorously test more interventions that can be
brought to scale and widely disseminated in the US.

One program, the Chronic Pain Self-Management Program (CPSMP), provides short-term
improvements in pain but its long-term effects have not been evaluated. This study will
examine the long-term effects of CPSMP in the medically underserved state of West Virginia
(WV). With one of the worst health profiles in the US, WV has the highest rates of arthritis,
diabetes, heart disease, and drug overdose deaths, and therefore has a compelling need for
the CPSMP. The objectives of this community-engaged, randomized, wait-list controlled study
are to: 1) determine the short- (26 weeks) and long-term (52 weeks) effectiveness of the
6-week CPSMP in adults with CP in WV; 2) evaluate the Reach (number of participants,
completers), Effectiveness (outcomes), Adoption (number of sites, leaders, trainings),
Implementation (fidelity), and Maintenance (satisfaction, continuation) of CPSMP using the
RE-AIM Framework; and 3) disseminate the results to key stakeholders including evidence-based
organizations, public health practitioners/researchers, and healthcare providers.

The study will enroll 240 participants in 24 workshops at 12 community-based sites in 2
counties in WV, Greenbrier (rural) and Wood (urban). Participants will attend free, 2.5-hour
weekly sessions for 6 weeks. Two trained leaders will facilitate group discussions on
managing pain, emotions, depression, fatigue, and sleep; proper exercise, nutrition, and
medication use; weight management; strategies for effective communication with healthcare
professionals; evaluating treatments; and pacing/planning. Self-reported, performance-based,
and physiological data will be collected at baseline and 26, and 52 weeks after the start of
the intervention. The primary outcomes are pain (severity, quality, interference, medication
use), mental health (mood, anxiety, catastrophizing), function (self-efficacy, coping,
health-related quality of life, sleep, fatigue, communication, physical activity), healthcare
utilization, missed work days, and gait speed.

Inclusion Criteria:

- Adults over age 18

- Have chronic pain (pain on most days or everyday) for the past 3 months or more

- Able to attend 1 CPSMP workshop a week over 6 weeks

- Able to attend 3-4 testing sessions for data collection (testing sessions are
scheduled before the workshops begin and then six months, one year and, for those
assigned to the control group, one and a half years after the start of the study)

Exclusion Criteria:

- Chronic pain caused by current cancer diagnosis or an open wound

- Lack reliable transportation

- Having surgery for the painful area in the next year

- Not community-dwelling (i.e., living in a nursing home, assisted living or personal
care home, mental hospital, or correctional facility)

- Not willing to be randomized to either start CPSMP workshop now or in six months

- Participation in another self-management program (e.g., Diabetes Self-Management
Program) in the past 12 months

- Unable to speak English