New study will evaluate ‘virtual’ approaches to pain management

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There is no magic bullet for people who experience long-term debilitating pain. Managing chronic pain and getting back to normal activities requires changes in lifestyle, thinking and coping skills. What works for one person doesn’t always work for another—even if the pain is related to the same underlying condition. That’s one of the conclusions that Dawn Ehde, Ph.D., professor of Psychology and Rehabilitation Medicine at the University of Washington (UW), has reached after decades of research into the management of chronic pain. Our best evidence suggests that a variety of treatments including exercise, physical therapy, cognitive behavioral therapy and mindfulness meditation can help people in terms of reducing pain and its interference with life. This is probably more accurate in terms of the science-these can reduce pain and how much pain interferes with life.

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Such comprehensive approaches to pain management are far easier to access for people in urban areas with major medical centers, yoga studios and other health- and wellness-related programs. Ehde has long been concerned about reaching people in pain who live in small towns and rural areas where such resources are scarce or non-existent. That’s why she is leading a new study at the Center for Rehabilitation Outcomes Research (CROR) that will test whether cognitive behavioral therapy (CBT) delivered by mobile phones or computers is effective in reducing pain levels for those living and working with chronic back pain.

People eligible for the study include those with spinal cord injuries, amputations, multiple sclerosis, neuromuscular diseases, traumatic brain injury and stroke. Ehde is looking to enroll 200 people, half through the Shirley Ryan AbilityLab and half through the University of Washington Medical Center in Seattle. One group will participate in eight 45-minute sessions of CBT that teach them pain-management skills such as relaxation and mindfulness meditation. The control group will be wait-listed and receive the same intervention at a later date.

If the study finds, as Ehde expects, that the treatment reduces pain for the participants, it will be another step forward in showing the benefits of “virtual” therapy delivery for those dealing with chronic pain. “CBT has already been validated but we want to fine-tune the intervention for people with pain at work,” Ehde says. “We’re adapting the treatment to make it more relevant to employed people who are dealing with chronic pain.”

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Ehde’s study is one of four being funded by a $4.3 million five-year grant from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) to add to knowledge about barriers that deter people with disabilities from finding jobs or staying employed. Only about 10 percent of people with disabilities who want to work actually hold jobs, and pain interference is likely one of the reasons why. Some researchers estimate that as many as 100 million U.S. adults, or almost a third of the population, have lived with chronic pain at some point.

“Dawn is renowned for her cutting-edge research using tele-rehabilitation methods to improve the quality of life of people with chronic illness and disability,” says CROR Director Allen Heinemann, Ph.D. “She is passionate about her work, compassionate with those we serve, and is a dearly valued colleague. She is highly prolific and her research publications generate thousands of citations.”

In a 2014 article in the American Psychologist, Ehde laid out the case for expanding the use of CBT in people with chronic pain. Even though CBT had become the gold standard psychological treatment for a wide range of pain problems, “Unfortunately, most individuals with chronic pain never receive CBT,” she wrote. “Integration of CBT into medical settings where individuals with chronic pain are commonly seen, especially primary care settings, offers much promise in both expanding application of CBT and improving outcomes, but such approaches are only beginning to be studied.”

Ehde’s current study builds on one she conducted four years ago into whether pain self-management coaching delivered by telephone could reduce pain, fatigue and depression in adults across the U.S. who had multiple sclerosis, a neuro-degenerative disease that results in moderate to severe chronic pain in about 50 percent of patients. In the randomized control trial, one group received counseling and behavioral skill building over the phone while the other received general education about MS.

The research team was hoping for a 50 percent or more decrease in one or more symptoms, and that was what they found. Fifty-eight percent in the self-management group achieved the goal, compared with 46 percent of those in the education group. Both groups significantly improved, and those improvements were generally maintained at six and 12 months. “The study demonstrated that the telephone is an effective method for engaging participants in care and extending the reach of rehabilitation for individuals with MS,” the researchers wrote in the Archives of Physical Medicine and Rehabilitation.

Ehde is hoping that tele-health will be a particularly effective way of delivering therapy to people in the workplace. To adapt the CBT materials to be more relevant to employed people, she is talking with vocational counselors and people who work in pain management programs. She also hopes to teach people ways to proactively engage with their employers while they are learning their new pain management skills. “Maybe people will need to stand up or move around. Maybe a standing desk would help,” she says. “Or maybe it would help to have a quiet place to meditate. We’d like to show them how to make that an easier conversation with their employer that gets the job done.”