Linda Rogers of San Antonio loves caring for children, including her own grandchildren. This summer in her home, she is watching and cooking for six youths ranging in age from 1 to 12. She has little time to be bogged down with aches and pains.
Rogers, 51, has coped with chronic pain from neuropathy, gout and rheumatoid arthritis for 10 years. A couple of years ago, she was approached about participating in a six-month chronic pain self-management program developed by a team at UT Health San Antonio and The University of Texas at San Antonio (UTSA).
Rogers and other patients with chronic non-cancer pain were studied in a clinical trial. Study participants were randomized to receive the program in two settings: monthly one-on-one clinic meetings with a community health worker trained as a chronic pain health educator, or group lectures presented by physicians and other health care providers at a local library.
At the end of the program, participants in both arms of the study showed a clinically significant improvement in the primary outcome measure, which was the time it takes to perform a five times sit-to-stand test. Faster performance on this test is associated with a lower likelihood of future falls and disability.
A strategy for life
“The program gave me long-lasting tools to manage my pain,” Rogers said. “It’s an innovative way to keep off medication.”
She is doing morning stretching to relieve muscle tightness and evening stretching to sleep better. As she cooks, she is doing knee bends, lifting one leg four times and then the other leg four times. “It helps work out the kinks,” she said. She is also practicing breathing exercises.
The “Living Better Beyond Pain/Vivir Mejor Más Allá del Dolor” self-management program is being studied as an affordable and practical resource to help primary care clinics serve chronic pain patients through non-drug approaches, said Barbara J. Turner, M.D., M.S.Ed., M.A., MACP. The program explores diet, sleep, goal-setting, mindfulness and meditation, and physical activities such as stretching, walking and gentle muscle strengthening.
Dr. Turner, professor of medicine in the Joe R. & Teresa Lozano Long School of Medicine at UT Health San Antonio, is lead author of a study that evaluated whether program participants such as Rogers would improve in how well they function. Results were published this May in the Journal of General Internal Medicine.
Effect of pain on performance
“The sit-to-stand test and other assessments are useful ways to quantify what people can do and also quantify where function is compromised,” said study co-author Maureen Simmonds, Ph.D., PT, professor of physical therapy in the School of Health Professions at UT Health San Antonio.
Dr. Simmonds in 1998 developed the Simmonds Performance Battery, a collection of tests that quantify, for example, the effect of health conditions, pain and aging on performance.
“When people improve, we are able to show that, to measure it,” she said.
Overcoming fear of pain
In the program, patients with chronic pain learn to separate themselves from the fear that often accompanies their pain, Dr. Simmonds noted.
“Most people understand acute pain is tied to tissue injury,” she said. “The assumption is that a little bit of pain is associated with a small injury, and if the pain increases in intensity, it must mean something more severe is happening. However, although acute pain may be associated with tissue injury, this is NOT the case with chronic pain. Worries about persistent pain and what it may mean become scary and threatening.
“This program explains that if we get going, and don’t wait for the pain to disappear totally, it will diminish as we get moving,” Dr. Simmonds said.
Primary care ramifications
The study confirmed that a community health worker who is trained in the curriculum can effectively extend a primary care team’s outreach to patients with chronic pain, Dr. Turner said.
“Chronic pain self-management training is an obvious missing component of routine primary care, but it has not been delivered in a way that could be affordably implemented,” Dr. Turner said.
Primary care practices could offer the program to chronic pain patients much as they currently offer diabetes self-management programs to diabetic patients. The ramifications are clear.
“We have this huge national opioid crisis, and we aren’t talking enough about, after we cut down on prescribing drugs, what can we offer people,” Dr. Turner said. “Not a second drug, believe me. It’s not going to work.
“This program, offered in the primary care setting, is meant to fill that gap.”
In the end, a better life
“The program taught me that medication is only a supplement to help with pain,” Rogers said. “If you can use other methods, it’s better than getting hooked on medication. The main idea of the program was for us to manage pain to have a better quality of life.”
Dr. Turner is the former founding director and Dr. Simmonds is a scholar with the Research to Advance Community Health (ReACH) Center at UT Health San Antonio. Zenong Yin, Ph.D., professor of health and kinesiology at UTSA; Yuanyuan Liang, Ph.D., professor at the University of Maryland School of Medicine; and Natalie Rodriguez of ReACH collaborated on the study.