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A new online treatment programme, set up by expert psychologists and physiotherapists at NUI Galway, aimed at helping those who suffer from chronic pain, has been extended due to popular demand.
The Centre for Pain Research at NUI Galway, with the support of the Health Research Board, is currently recruiting people with chronic pain (pain which has lasted for three months or more), with recruitment to continue until the end of April.
The aim of the project is to determine whether an online psychological pain management programme is effective among people who suffer with chronic pain, something which has not been investigated to date in Ireland.
Chronic pain affects up to 35 per cent of the Irish population and is increasingly recognised as a disease in its own right. Chronic pain is sometimes associated with psychological effects, which may include anxiety and changes in mood, as well as forgetfulness, difficulties in focusing attention, planning tasks and making decisions.
The NUI Galway Acceptance and Commitment Therapy (ACT) trial is based on emerging clinical science that demonstrates the usefulness of managing chronic pain through mindfulness and psychological wellbeing.
The trial provides eight online sessions to people in the comfort of their own home. At the moment, such supports are mainly available through specialised hospital-based pain management teams.
The sessions, which are free of charge, focus on values and goals that are individual to each person in the trial.
Participants are provided with instructions on a range of activity-pacing techniques to encourage more consistent levels of activity from day-to-day. In addition, mindfulness techniques and cognitive behavioural therapy help identify both negative thinking patterns and the development of effective challenges. Participants also develop a greater understanding of the individual’s role in pain management and training in mindfulness techniques tailored for chronic pain management.
People who take part in the ACT trial will not need to attend any clinic or the university at any stage. All materials are tailored for those wishing to learn effective ways of managing their chronic pain. Participants can access physiotherapy and all medical services as usual while involved in the trial.
People who take part in the ACT trial will not need to attend any clinic or the university at any stage. All materials are tailored for those wishing to learn effective ways of managing their chronic pain
When this research project is concluded, all participants who have completed the programme will receive a summary of the main findings.
The study is open to people all over Ireland and is currently taking place. GPs and physiotherapists around the country are being encouraged to refer suitable people with pain to the study. The researchers are specifically interested in hearing from people who have had pain for three months or longer and have regular access to a computer and the Internet.
Study supervisor Dr Brian McGuire said: “This is a promising new online pain management programme and we are hopeful it will be of benefit to people with chronic pain.”
GPs or physiotherapists who are interested in referring suitable patients to the trial should log onto www.nuigalway.ie/centre-for-pain-research/ or alternatively, phone 091 495391.
Speaking to the Medical Independent, Dr Christopher Dwyer, Co-ordinator of the study and post-doctoral researcher at the Centre for Pain Research at NUI Galway, said the online programme could really expand the availability of psychological therapy for patients.
“We know that psychological therapies provided to people with chronic pain are beneficial, particularly for people at risk of long-term disability. However, this type of service is often only accessible via specialised hospital-based pain management teams. In this trial, we will offer this type of service to people all over the country and at any stage of injury,” he said.
Currently, most online interventions of this nature are cognitive behavioural therapy (CBT) based, while this one, as it is based on ACT, is different, he noted. “Generally, CBT is focused on changing the way we think about pain, while ACT is focused on, as it ‘says on the tin’, accepting it and being aware of it and not trying to say ‘I’m not in pain, I’m not in pain’. But by saying ‘I am in pain’ and leaving it at that and trying to focus on the things you want to achieve in your daily routine and the goals you have and focus more on them while at the same time accepting but not dwelling on the pain itself,” Dr Dwyer explained.
About 300 people to date have been recruited to trial the programme, with recruitment continuing until the end of April,
While most of the programme has been prepared so it can be accessed online at a convenient time, certain aspects of the programme are live, he continued. “We have a team that will answer emails and phone calls on a day-to-day basis. It is tailored for each individual. While the modules are pre-developed, based on any questions or uncertainties people have, they can contact a member of our team regarding what they should be doing, can do, etc.”
As the programme commenced last November, some participants have come through it already and there are some interesting initial findings, Dr Dwyer said. “It is early days so far, but the feedback we have gotten has been positive. Although a lot of people have had some trouble with timing, with holidays and things like that, because it is online, people might forget. But that is the beauty of it; it is flexible. So if something does come up in your life you can put it off for an hour or two, or indeed a day or two, so they really like that aspect of it, as opposed to having to be at a certain place at a certain time — that kind of routine.
“With the content itself, people have been very receptive to it and they really like the message behind it. Many of them have identified that it is grounded in mindfulness.
“They are very happy with it and were looking into it themselves, so positive feedback in that respect.”
Dr Dwyer said depending on the results of the programme trial, the team will be looking at how to “best tailor the intervention for GP dissemination”.
“Despite over 35 per cent of Irish adults suffering from chronic pain, it is something that gets brushed under the rug quite a bit… chronic pain is different from person to person, and I think treatment is different from person to person. I think some people are very receptive to medication and some people need a little more. And likewise any type of treatment, any psychological treatment, all depends on the disposition of the person… it comes down to the GP as well in where their patient is at and what they might be open to.”
He added that in the coming months, the programme team will also branch-out into looking at patients with multimorbidity and chronic pain.
Children’s pain programme
Researchers from the School of Psychology and Centre for Pain Research at NUI Galway are also currently recruiting children age six-to-10 years with chronic pain and their parents or caregivers to take part in an online pain management programme for children.
The programme, ‘Feeling Better’, has been developed to help children and parents to manage chronic pain for a better quality of life. This web-based programme is based on the principles of CBT, which has shown to be effective in the management of chronic pain, in traditional face-to-face therapy and group treatment.
The Feeling Better study is unique in that a trial of this nature has not been investigated to date in Ireland. The programme is currently the only widely-available source of interactive, online therapeutic support for school-age children with chronic pain in Ireland.
Studies suggest up to 10 per cent of five- to 12-year-old Irish children report chronic or persistent pain, including abdominal pain, back pain, musculoskeletal pain, headache and widespread pain. Chronic pain is often associated with psychological effects, which may include changes in mood and difficulty with focusing attention and performance at school. This can have a significant impact on day-to-day quality of life.
The study is open to children with any type of chronic or persistent pain (pain which has lasted for three months or more). Pain support groups, parent-led networks, GPs and physiotherapists around the country are encouraged to get in touch and to refer suitable people with pain to the study.
Benefits to participants include access to a free online pain management programme and training in CBT techniques tailored for chronic pain management and school-age children.
Clinical psychologists and researchers at NUI Galway developed the online programme with input from families currently coping with chronic pain. School-age children with chronic pain and their caregivers were involved in the design and development process.
Fun and engaging
Evidence-based psychological strategies were selected to address areas of pain management children and parents identified as most challenging and important. This influence ensures Feeling Better is a fun and engaging form of online therapeutic support designed by children with pain for children with pain, according to the research team.
The programme involves nine weekly online sessions. Each session is designed to take approximately 30-minutes to complete and all participants are guided through the programme by a ‘coach’ who is available to provide feedback and advice on a regular basis.
Each week, a fun, pirate-themed, interactive programme will introduce children to new skills in the form of ‘challenges’ and weekly ‘missions’ (treatment sessions), which they must complete in order to progress in their training. Participating children will begin the programme as a ‘Powder Monkey’ and must earn a promotion with each mission until they succeed to ‘Captain’ and claim their treasure. Parents are encouraged to take the role of ‘coach’ and are separately guided through a complementary section of the programme, where they are provided with information, tips for practice and tools to help with day-to-day pain management. Weekly sessions are tailored to participants’ goals, support needs and coping preferences.
Children and parents will learn more about psychological strategies, which focus on techniques such as relaxation training, activity pacing, attention management, communication skills and the influence of thoughts and emotions on the experience of pain.
This programme is part of a research project being carried out at NUI Galway by PhD candidate and Hardiman scholar Ms Angeline Traynor and led by Dr McGuire.
“Chronic pain is thought to be predictive of long-term complaints and disability. Given the impact of chronic pain, it is essential to provide a means of support for young children with respect to pain management. Learning coping strategies at an early age may have long-term benefits for the child and the family as a whole. Our hope is that this online programme will overcome access and resource issues which may be preventing families from receiving psychological treatment to support pain management,” Ms Traynor said.
For further information and to refer patients to the study, contact Ms Angeline Traynor at firstname.lastname@example.org and 086 0378562 or visit www.feelingbetter.ie.