Randomized Controlled Trial

. 2023 Aug 25:25:e47284.

doi: 10.2196/47284.

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

Katrine Bostrøm^{1

2}, Elin Børøsund^{1

3}, Hilde Eide^{1

4}, Cecilie Varsi^{1

5}, Ólöf Birna Kristjansdottir^{1

6

7}, Karlein M G Schreurs⁸, Lori B Waxenberg⁹, Karen E Weiss¹⁰, Eleshia J Morrison¹⁰, Hanne Stavenes Støle^{1

11}, Milada Cvancarova Småstuen¹², Audun Stubhaug^{2

13

14}, Lise Solberg Nes^{1

2

10}

Affiliations

¹ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
⁴ Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
⁵ Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
⁶ Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway.
⁷ Mental Health Team West, Primary Care of the Capital area, Reykjavik, Iceland.
⁸ Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.
⁹ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.
¹⁰ Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States.
¹¹ Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.
¹² Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
¹³ Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.
¹⁴ Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway.

PMID: 37624622
PMCID: PMC10492177
DOI: 10.2196/47284

Randomized Controlled Trial

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

Katrine Bostrøm et al. J Med Internet Res. 2023.

. 2023 Aug 25:25:e47284.

doi: 10.2196/47284.

Authors

Affiliations

¹ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
⁴ Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
⁵ Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
⁶ Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway.
⁷ Mental Health Team West, Primary Care of the Capital area, Reykjavik, Iceland.
⁸ Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.
⁹ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.
¹⁰ Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States.
¹¹ Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.
¹² Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
¹³ Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.
¹⁴ Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway.

PMID: 37624622
PMCID: PMC10492177
DOI: 10.2196/47284

Abstract

Background: 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.

Objective: 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.

Methods: 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 pain interference (Brief Pain Inventory; primary outcome measure), anxiety and depression (Hospital Anxiety and Depression Scale), self-regulatory fatigue (Self-Regulatory Fatigue 18 scale), health-related quality of life (SF-36 Short Form Health Survey), pain catastrophizing (Pain Catastrophizing Scale), and pain acceptance (Chronic Pain Acceptance Questionnaire). Linear regression models used change scores as the dependent variables.

Results: 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 (P=.84), but significant reductions in the secondary outcomes of depression (mean difference -0.90; P=.03) and self-regulatory fatigue (mean difference -2.76; P=.008) in favor of the intervention group. No other statistically significant changes were observed at 3 months (all P>.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%).

Conclusions: 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.

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

Keywords: acceptance and commitment therapy; chronic pain; cognitive behavioral therapy; digital health; efficacy; self-management.

©Katrine Bostrøm, Elin Børøsund, Hilde Eide, Cecilie Varsi, Ólöf Birna Kristjansdottir, Karlein M G Schreurs, Lori B Waxenberg, Karen E Weiss, Eleshia J Morrison, Hanne Stavenes Støle, Milada Cvancarova Småstuen, Audun Stubhaug, Lise Solberg Nes. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.08.2023.

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Conflict of interest statement

Conflicts of Interest: LSN is an unpaid board member of dHealth AS, a company eventually aiming to commercialize the EPIO program. All other authors declare no other conflicts of interest.

Figures

**Figure 1**
Example screenshots of the EPIO intervention program.

**Figure 2**
Recruitment and participant flow.

See this image and copyright information in PMC

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical