Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO

Lise Solberg Nes^{1

2

3}, Elin Børøsund^{1

4}, Cecilie Varsi^{1

5}, Hilde Eide^{1

6}, Lori B Waxenberg⁷, Karen E Weiss³, Eleshia J Morrison³, Hanne Stavenes Støle^{1

8}, Ólöf B Kristjansdottir^{1

9

10}, Katrine Bostrøm¹, Elin Bolle Strand^{1

11}, Milada Cvancarova Småstuen Hagen¹², Audun Stubhaug^{2

13

14}, Karlein M G Schreurs¹⁵

Affiliations

¹ Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
⁴ Department of Nursing and Health Sciences, 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 Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
⁷ Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
⁸ Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.
⁹ Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway.
¹⁰ Mental Health Team West, Primary Care of the Capital Area, Reykjavik, Iceland.
¹¹ Institute of Health, Faculty of Health Science, VID-Scientific University, 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.
¹⁵ Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands.

PMID: 38962688
PMCID: PMC11221858
DOI: 10.1097/PR9.0000000000001174

Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO

Lise Solberg Nes et al. Pain Rep. 2024.

. 2024 Jul 2;9(4):e1174.

doi: 10.1097/PR9.0000000000001174. eCollection 2024 Aug.

Authors

Affiliations

¹ Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
⁴ Department of Nursing and Health Sciences, 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 Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
⁷ Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
⁸ Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.
⁹ Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway.
¹⁰ Mental Health Team West, Primary Care of the Capital Area, Reykjavik, Iceland.
¹¹ Institute of Health, Faculty of Health Science, VID-Scientific University, 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.
¹⁵ Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands.

PMID: 38962688
PMCID: PMC11221858
DOI: 10.1097/PR9.0000000000001174

Abstract

Introduction: Chronic pain affects a wide range of physical and psychological aspects of life for those impacted. Psychosocial treatment approaches may be of support, but outreach is still limited.

Objectives: To evaluate the efficacy of EPIO, an evidence-informed, user-centered digital self-management intervention for people with chronic pain, in a 12-month randomized controlled trial.

Methods: People living with chronic pain (N = 266) were randomized to the EPIO intervention (n = 132) or a usual-care control group (n = 134). The intervention was delivered in a simple blended care model, and outcome measures collected at baseline, 6 months, and 12 months. Generalized linear models for repeated measures were fitted to compare groups over time.

Results: Participants were primarily female (81%), median age 49 years (range 22-78), with heterogeneous pain conditions, and had lived with pain >5 years (77.6%). A mixed linear model with all timepoints included revealed no statistically significant group differences for the primary outcome of pain interference. Significant psychological benefits in favor of the intervention group were however detected for depression (P = 0.022), self-regulatory fatigue (P = 0.024), vitality (P = 0.016), and mental health (P = 0.047). Baseline to 12-month changes showed additional favorable effects for anxiety (between-group mean differences [MDs] = 0.79, P = 0.047), depression (MD = 1.08, P = 0.004), self-regulatory fatigue (MD = 2.42, P = 0.021), pain catastrophizing (MD = 2.62, P = 0.009), and health-related quality of life.

Conclusions: The EPIO program aims to improve outreach of evidence-based pain self-management interventions. Findings demonstrate how using EPIO can lead to sustainable psychological change, enhancing mental health and health-related quality of life for people suffering from pain, providing a chance to live well with the pain.

Keywords: Acceptance and commitment therapy; Anxiety; Chronic pain; Cognitive behavioral therapy; Depression; Digital pain self-management; Pain interference; Psychosocial self-management; Self-regulatory fatigue; eHealth.

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Conflict of interest statement

L.S.N. is an unpaid board member of the company dHealth AS, aiming to market the EPIO program for commercialization, but has no financial interest in the company. The remaining authors have no conflicts of interest to declare. This study was funded by the Norwegian Research Council (Grant #256574, Principal Investigator L.Solberg Nes). Data sets from this study are, due to the nature of patient sensitive information, not available for public sharing through public archives or repositories. Deidentified data from this study will however be made available in accordance with institutional standards through contacting the corresponding author. Trial Registration: ClinicalTrials.gov NCT03705104.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

**Figure 3.**
CONSORT flow diagram describing enrollment, allocation, follow-up for the 12-month EPIO study. Participants not completing outcome measures are referred to as “Nonresponders.”

See this image and copyright information in PMC

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Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO

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Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO

Authors

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Abstract

Conflict of interest statement

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References

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