Rheumatology Practice Management September 2013 Vol 1 No 1 — September 11, 2013

New Orleans, LA—An interactive, online tool shows promise in helping patients with rheumatoid arthritis (RA) self-manage their pain and could prove to be a useful adjunct to office visits for this patient population, according to a poster presented at the 2013 American Pain Society annual meeting by a team of investigators from Inflexxion, Newton, MA. They presented findings from an intervention called painACTION, an online program for the self-management of patients with pain associated with rheumatic disease.

Participants in this program had improved outcomes in pain relief, awareness about their condition, and self-management behaviors, as well as improved mood and coping skills and better quality of life compared with controls with a similar level of RA pain at baseline.

“These improvements in participants’ pain self-efficacy, pain catas­trophizing, coping through relaxation, and quality of life indicate that painACTION can be an important element of a comprehensive disease management program for people with arthritis pain. Further research is needed to determine which subgroups can be most effectively treated by an online intervention and to better understand why some dimensions changed after exposure to the treatment, while others did not. Pain­ACTION may help meet the public health need for arthritis education,” according to Kimberlee J. Trudeau, PhD, of Inflexxion.

Engaging Patients with RA in Their Disease Management

One in every 5 adults in the United States is affected by arthritis, and in 2000, the US Department of Health and Human Services set a goal of disseminating arthritis education to more patients.
Self-management is a critical component in helping patients to learn how to identify, avoid, and manage their pain, but physicians typically do not have time to provide patient education of this nature. Internet-based programs have been shown to improve outcomes among people with back pain and migraine.

The investigators developed and tested the online, interactive self management program for adults who suffer pain associated with osteoarthritis (OA), RA, ankylosing spondylitis, and other rheumatic conditions based on principles of Social Cognitive Theory (Bandura, 1997). The motto of the program is, painACTION “picks up where the office visit leaves off.”

The Program

A total of 228 participants (mean age, approximately 50 years) were recruited via flyers and online posting. All participants had moderate-to-severe pain associated with RA, as reflected by a self-reported pain level of ≥4 in the previous week on the 0 to 10 Numerical Rating Scale. The experimental group comprised 113 patients who participated in painACTION, who were compared with 115 controls.

Approximately 68% of the participants were female, and approximately 44% were college graduates. Approximately 53% of both groups had RA, 60% had OA, and 7% had other arthritic conditions.

Participants used painACTION twice weekly for 4 weeks, followed by 5 additional monthly booster sessions. The painACTION program included articles, lessons, and interactive tools to facilitate learning pain self-management skills.

Participants had significantly improved pain control at 1-month and 6-month follow-up, reduced pain ca­tastrophizing at 6-month follow-up, and increased relaxation coping at 3-month follow-up. In addition, participants had improved patient perception of global change at 1-month, 3-month, and 6-month follow-up compared with controls.

By contrast, no significant differences between the groups were found in the effect of the intervention on pain awareness, the use of self-management strategies, pain level, and functioning. More research is needed to understand these effects, the investigators said.

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