Effect of self-management interventions on high impact chronic pain prevalence.

Among persons with High Impact Chronic Pain (HICP), we assessed the impact of cognitive behaviorally-based self-management interventions on sustained HICP and on favorable chronic pain outcomes (mild or discontinued chronic pain). Adults with HICP (N=2331) were randomly assigned to: a remote 8-session Health Coach intervention; an 8-session self-completed on-line painTRAINER program; or to Usual Care Plus educational materials. Participants were re-assessed at 3, 6 and 12 months. At 3 months, favorable chronic pain outcomes were somewhat more common among intervention participants than controls, but rates of sustained HICP were similar across all three study groups. At 6 and 12 months, over 40% of intervention participants reported favorable chronic pain outcomes compared to about 30% of Usual Care Plus participants. At 6 and 12 months, 36-42% of intervention participants had sustained HICP, compared to 50-52% of Usual Care Plus participants. At 3 months, relative risk confidence intervals for sustained HICP for the two intervention groups (compared to Usual Care Plus) included 1.0 indicating differences within chance expectation. At 3 months, relative risks of favorable chronic pain outcomes were 1.43 for painTRAINER and 1.39 for Health Coach interventions, compared to Usual Care Plus. At 6 and 12 months, relative risks for sustained HICP were about 0.8 for painTRAINER and Health Coach participants (compared to Usual Care Plus), while relative risks of a favorable chronic pain outcome were 1.24-1.44. Among participants with HICP, self-management interventions modestly reduced rates of sustained HICP and increased favorable chronic pain outcomes.