Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial (Preprint)

Abstract

Chronic pain conditions involve numerous physical and psychological challenges, and while psychosocial self-management interventions can be of benefit for people living with chronic pain, such in-person treatment is not always accessible. Digital self-management approaches could improve this disparity, potentially bolstering outreach and providing easy, relatively low-cost access to pain self-management interventions.

This randomized controlled trial aimed to evaluate the short-term efficacy of EPIO (ie, inspired by the Greek goddess for the soothing of pain, Epione), a digital self-management intervention, for people living with chronic pain.

Patients (N=266) were randomly assigned to either the EPIO intervention (n=132) or a care-as-usual control group (n=134). Outcome measures included <i>pain interference</i> (Brief Pain Inventory; primary outcome measure), <i>anxiety</i> and <i>depression</i> (Hospital Anxiety and Depression Scale), <i>self-regulatory fatigue</i> (Self-Regulatory Fatigue 18 scale), <i>health-related quality of life</i> (SF-36 Short Form Health Survey), <i>pain catastrophizing</i> (Pain Catastrophizing Scale), and <i>pain acceptance</i> (Chronic Pain Acceptance Questionnaire). Linear regression models used change scores as the dependent variables.

The participants were primarily female (210/259, 81.1%), with a median age of 49 (range 22-78) years and a variety of pain conditions. Analyses (n=229) after 3 months revealed no statistically significant changes for the primary outcome of pain interference (<i>P</i>=.84), but significant reductions in the secondary outcomes of depression (mean difference −0.90; <i>P</i>=.03) and self-regulatory fatigue (mean difference −2.76; <i>P</i>=.008) in favor of the intervention group. No other statistically significant changes were observed at 3 months (all <i>P</i>&gt;.05). Participants described EPIO as useful (ie, totally agree or agree; 95/109, 87.2%) and easy to use (101/109, 92.7%), with easily understandable exercises (106/109, 97.2%).

Evidence-informed, user-centered digital pain self-management interventions such as EPIO may have the potential to effectively support self-management and improve psychological functioning in the form of reduced symptoms of depression and improved capacity to regulate thoughts, feelings, and behavior for people living with chronic pain.

ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104