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Health Services Research & Development

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HSR&D Citation Abstract

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Higgins DM, Buta E, Williams DA, Halat A, Bair MJ, Heapy AA, Krein SL, Rajeevan H, Rosen MI, Kerns RD. Internet-based pain self-management for veterans: Feasibility and preliminary efficacy of the Pain EASE program. Pain practice : the official journal of World Institute of Pain. 2019 Nov 28.
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Abstract: OBJECTIVE: To develop and test the feasibility and preliminary efficacy of a cognitive behavioral therapy-based, internet-delivered self-management program for chronic low back pain (cLBP) in veterans. METHODS: Phase I included program development, involving expert panel and participant feedback. Phase II was a single-arm feasibility and preliminary efficacy study of the Pain EASE (i.e., Pain e-health for Activity, Skills, and Education) program. Feasibility (i.e., website use, treatment credibility, satisfaction) was measured using descriptive methods. Mixed models were used to assess mean within-subject changes from baseline to 10 weeks post-baseline in pain interference (primary outcome, West Haven-Yale Multidimensional Pain Inventory, 0-6 scale; WHYMPI), pain intensity, mood, fatigue, sleep, and depression. RESULTS: Phase I participants (n = 15) suggested modifications including style changes, content reduction, additional "Test Your Knowledge" quizzes, and CBT skill practice self-monitoring form revisions for enhanced usability. In Phase II, participants (n = 58) were mostly male (93%), white (60%), average age 55 (SD = 12), with moderate pain (mean 5.9/10), and 41 (71%) completed the post-baseline assessment. Participants (N = 57) logged on 6.1(SD = 8.6) times over 10 weeks and 85% reported being very or moderately satisfied with Pain EASE. Pain interference improved from a mean of 3.8 at baseline to 3.3 at 10 weeks (difference 0.5 (95% CI 0.1 to 0.9), p = 0.008). Within-subject improvement also occurred for some secondary outcomes including mood and depression symptoms. DISCUSSION: Veterans with cLBP may benefit from technology-delivered interventions, which may also reduce pain interference. Overall, veterans found that Pain EASE, an internet-based self-management program, is feasible and satisfactory for cLBP.

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