Major Depressive Disorder Indicated With 54 Percent Of Participants In Chronic Pain Study

Chronic Pain researcher Marian Wilson, PhD, MPH, RN-BC, an Assistant Professor at Washington State University College of Nursing in Spokane, Washington, is now actively recruiting people with any chronic illness and depressive symptoms to test an online depression program.

“My goal is to address the under-treated and under-detected depression in those with chronic disease that leads to worsening of overall health outcomes,” says Dr Wilson, who is is board certified in Pain Management Nursing from the American Nurses Credentialing Center & American Society for Pain Management Nursing, and has experience as a nurse scientist leading clinical research in acute care settings.

The program was developed by Goalistics, a company founded by two psychologists, Dr. Linda Ruehlman and Dr. Paul Karoly for the purpose of developing affordable and easy-to-use computer-based tools to aid in treatment for chronic pain and depression.

Drs. Ruehlman and Karoly have been awarded 10 research grants from the National Institute of Neurological Disorders and Stroke and the National Institute of Mental Health, funds from which were used to study and develop several different assessment tools and training programs, including the Multidimensional Health Profile, the Profile of Chronic Pain, and the Pain Self-Management Program. These tools help people manage psychological, social, and health-related problems that are often treated in mental health or physical health care settings.

The Goalistics partners also note that unfortunately several barriers stand in the seeking of face-to-face treatment for millions of people, including inadequate finances, reluctance to see, and reduced access in rural areas, one highly cost-effective avenue for making inroads into this problem is use of technology as a supplement to the traditional administration of services.

Technology-based programs are affordable, self-paced, and available 24 hours a day to people with reduced access to traditional treatment, such as people living in rural areas, with communication or other disabilities, with busy or inflexible schedules, or who lack child care, transportation, or insurance coverage.

Goalistics uses a variety of electronic tools to provide a uniquely dynamic foundation for learning such as DVD, online assessments and the scoring and reporting of data, interactive learning, electronic messaging, in-stream video, online discussion forums, as well as online data tracking and graphing. Features such as self-assessment, homework exercises, and self-monitoring can be created to suit the specific goals of a program.

Adults who suffer from a chronic medical condition and also struggle with depression may be interested in trying an online program designed to help learn how to deal with depressive symptoms better. Persons fitting that general profile may also be eligible to participate in a study to determine the effect of an 8-week program to improve depressive symptoms in people with chronic illnesses.

Potential benefits of participation include:

– An opportunity to learn how to manage your depressive symptoms better.

– Free access to the online program called “Think Clearly About Depression” that is based on principles of Cognitive Therapy.MThis program has videos, activities, and lessons designed to help you understand the role that thinking plays in depression. It helps participants to learn new skills such as recognizing and replacing negative thoughts and applying constructive thinking.

– Participants can earn gift cards of up to $30 for completing online surveys.

This study, headed by Dr. Wilson, has been reviewed and approved for human subjects participation from the Washington State University Institutional Review Board. For more information about the study, see the contact information at the end of this article.

Dr. Wilson notes that her previous published research found that people treated in emergency departments for pain did not experience any improvements in depression, “thus validating our hunch,” she says, “that it was not addressed during the ED visit as it should be ideally. Pain outcomes improve when depression is treated concurrently.”

That study, entitled Depression and pain interference among patients with chronic pain after ED encounters (J Emerg Nurs. 2014 May;40(3):e55-61. DOI: http://dx.doi.org/10.1016/j.jen.2013.03.011), and published online in the Journal of Emergency Nursing, is coauthored by Dr. Wilson with Washington State University Spokane senior vice chancellor and principal investigator John Roll PhD; and fellow nursing faculty members Patty Pritchard, BSN, RN; Bat Masterson, RN, Donelle Howell, PhD; and Celestina Barbosa-Leiker, PhD.

The investigators found that patients with chronic pain who frequent emergency departments present a challenge to health care providers, since mental health, substance abuse, and pain issues are difficult to distinguish in fast-paced clinical settings, in which significant symptoms may remain unaddressed. This pilot study sought to determine whether electronically delivered screening tools measuring pain and mood could identify areas to target for improving emergency care.

The researchers used repeated measures of validated instruments to investigate the status of patients after a visit to an emergency department, and persons with chronic pain not related to cancer, and/or documented opioid use, were recruited by nursing personnel after an ED encounter. Fifty-two consenting participants were invited to perform an online survey that included self-reported measurements of pain intensity, pain interference, depression, subjective health, and health distress. The survey was repeated after 8 weeks.

The baseline survey was completed by 42.3% of 52 patients (number 22, 68.2 percent of whom were female). The mean pain severity score was 5.96 (SD 1.57) and the mean pain interference score was 7.52 (SD 1.81) using 0 to 10 scales of the Brief Pain Inventory. Personal Health Questionnaire Depression Scale ratings indicated that a major depressive disorder should be considered for 54% of the participants.

The investigators concluded that the surveys delivered to patients with chronic pain detected unmet needs for depression and persisting high levels of pain interference after ED encounters, and suggest that adding mood-specific screening tools to pain assessments may be necessary in clinical settings in order to to identify depression and refer patients for appropriate treatment.

“We also found in our recent online pain program study that more than one-half of those enrolled had moderately severe or higher rated depressive symptoms, says Dr. Wilson. “They were all under a provider’s care and were all prescribed opioid medicines so require routine medical oversight, [which] leads one to wonder how well their mental health needs were being addressed. Participants in the treatment and control group improved depressive symptoms equally and significantly over the course of the study, leading us to hypothesize that perhaps the attention received by the control group provided some benefit over time. We also wonder if by sharing the participants’ depression symptom survey scores with primary care providers as part of our study protocol, we may have prompted some changes in treatment that helped. The present study seeks to address those question more completely by including an ‘attention control’ group so we can see how much benefit comes from the online program itself versus attention from researchers. The second highest patient population enrolled in our online pain program study was people with fibromyalgia (29 percent) — second to spine conditions (45 percent).”

In an article published last month as a press corrected proof in the journal Pain Management Nursing entitled “Empowering Patients with Persistent Pain Using an Internet-based Self-Management Program” (DOI: http://dx.doi.org/10.1016/j.pmn.2014.09.009), Drs. Wilson, Roll, Corbett, and Barbosa-Leiker report on another randomized, controlled trial designed to determine the effectiveness of the Chronic Pain Management Program, an 8-week online i.ntervention targeting cognitive, emotional, behavioral, and social pain determinants

Program efficacy and engagement was evaluated for 92 individuals recruited from primary care practices and Internet sites who had received a diagnosis of chronic noncancer pain, and who had a current opioid prescription. Participants were randomly assigned to receive access to the intervention either immediately (treatment group) or after an 8-week delay (wait-list comparison). Biweekly self-report measurements were collected using online surveys on pain, depressive symptoms, pain self-management behaviors, and health care utilization during the 8-week trial. Additional measurements of opioid misuse behaviors, pain self-efficacy, and medicine regimens were completed at baseline and week 8. Results from analysis of variance showed that at week 8, the treatment group had significantly greater improvements on pain self-efficacy and opioid misuse measures than the wait-list comparison group. Engagement level was positively associated with improvements in pain intensity, pain interference, and pain self-efficacy.

The investigators note that opioid painkillers typically become less effective over time while actually increasing a user’s perception of pain, and that unique to their study was the discovery that more appropriate use of opioid medicines could be an unintended consequence of participation, and that patients on opioids were able to engage and demonstrate positive outcomes using an Internet-based self-management program, and with future efforts toward heightening engagement potentially further maximizing impacts.

For more information about these studies, phone 509-324-7443, visit http://nursing.wsu.edu or email DR. Wilson at marian.wilson(at)wsu.edu.

Sources:
Assistant Professor Marian Wilson, PhD, MPH, RN-BC — Washington State University College of Nursing
Goalistics
The Journal of Emergency Nursing
Pain Management Nursing

Image Credits:
Washington State University College of Nursing
Goalistics

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