Background & Aims
Pain is the most common reason for seeking healthcare. Pharmacological treatments alone may not effectively manage pain and utilizing nonpharmacologic and integrative options provide a more comprehensive patient focused approach. Hospital programs promoting such approaches exist, but there is minimal published data on program outcomes in socioeconomically disadvantaged populations who have limited resources and may have difficulty incorporating nonpharmacologic pain management modalities. Additionally, despite an increase in patients’ preferences for these types of approaches, most health care professionals have minimal training or time to educate patients on nonpharmacologic pain management options. To address this need, a pain coach patient education program providing customized education sessions on 18 topics and integrative pain management toolkits for home use was initiated in a safety-net hospital system serving a disadvantaged population.
Methods
This model pain education program and follow up phone surveys were registered with the affiliated university’s Quality Improvement Project Registry. Patients ? 14 years of age with pain and capacity to participate in coaching sessions were eligible. Exclusion criteria included cognitive impairment, suicidal or violent behavior, incarceration, severe uncontrolled pain, or critically illness. Services were provided in the emergency department (ED), inpatient, and outpatient settings. Patients were asked to complete surveys one-month after their coaching session to assess toolkit home utilization, adherence, and perceived program value. Survey responses from patients completing the survey between November 2021 to November 2023, along with demographic data, area deprivation index (ADI) percentile, pain type, and type of education and toolkit items provided during coaching sessions were analyzed. Descriptive statistics were performed using R statistical software.
Results
During the two-year study period, the program coached 1,835 patients and 442 (24%) completed the survey. Of those surveyed, the average age was 50 years (SD=16.1); most were female (69%), Black (57%), Non-Hispanic/Latino (98%), living in socioeconomic disadvantage (ADI M=76, SD=19.1], range 16-100), presenting for acute pain (53%), and coached in the ED setting (56%). Coaching sessions most often utilized hot/cold therapy gel packs (96%), 4 flat tires stress ball pain analogy (95%), and aromatherapy (94%). Most patients (88%) reported using the toolkit items received during their session at least once in the previous 30 days. Aromatherapy (53%), hot/cold therapy (48%) and stress ball pain analogy (37%) were the most common items used at home. Many reported using items daily (34%) or weekly (40%). Most (77%) reported their session as very helpful or helpful on a 5-point Likert scale (M=4.49, SD=0.84) and 83% would recommend the program to others.
Conclusions
A model pain coach education program and customized toolkit for managing pain at home benefits patients’ one-month after a single-coaching session including a high-minority, disadvantaged pain population with high ADI scores. At one month evaluation, most participants reported consistent home use of toolkit and educational items. Future plans include analysis of qualitative statements and assessment of program effects on other outcomes such as hospital re-admission and ED recidivism, opioid use, and cost-effectiveness. All program materials, including a pain coach program guide, educational brochures, and patient workbook are available as free access online for adaptation to other programs. This program offers patients and healthcare professionals a new model for nonopioid, integrative pain management alternatives supporting patient home management and efficacy.
References
Eucker SA, Foley S, Peskoe S, Gordee A, Risoli T, Morales F, George SZ. Willingness to use nonpharmacologic treatments for musculoskeletal pain in the emergency department: a cross-sectional study. Pain Rep. 2022 Aug 17;7(5):e1027. doi: 10.1097/PR9.0000000000001027. PMID: 35999902; PMCID: PMC9387978.
Hendry P, Sheikh S, Montague M, Lott M, Velasquez E, Menze N, Curtis M, Perl K, Bartow V, Crisp A. Patient Utilization and Feedback After a Novel Pain Coach Educator and Integrative Pain Management Toolkit Session in an Urban Academic Emergency Department. Supplement to Annals of Emergency Medicine 2023;82(4S): S121. https://doi.org/10.1016/S0196-0644(23)01222-2
Hendry, PL, Sheikh, S, Perl, K, Montague, M, Curtis, M; Bartow, V, Menze, N, Lott, M, Webb, K, Norse, A, Crisp, A, Fishe, J. (2024). (O-K4) Two-year Results from a New Model Pain Coach Educator Program and Integrative Discharge Toolkit for Pain Management in an Urban US Teaching Hospital and Emergency Department During COVID-19 Pandemic. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 25(1.1). https://dx.doi.org/10.5811/westjem.63024 Retrieved from https://escholarship.org/uc/item/3bq2m9qt
Lee B, Yang KC, Kaminski P, Peng S, Odabas M, Gupta S, Green HD Jr, Ahn YY, Perry BL. Substitution of Nonpharmacologic Therapy With Opioid Prescribing for Pain During the COVID-19 Pandemic. JAMA Netw Open. 2021 Dec 1;4(12):e2138453. doi: 10.1001/jamanetworkopen.2021.38453. Erratum in: JAMA Netw Open. 2022 Jan 4;5(1):e2146308. PMID: 34889946; PMCID: PMC8665369.
Leake HB, Moseley GL, Stanton TR, O’Hagan ET, Heathcote LC. What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education. Pain. 2021 Oct 1;162(10):2558-2568. doi: 10.1097/j.pain.0000000000002244. PMID: 33960326.
Montague, M, Sheikh, S, Hendry, P, Menze, N, Perl, K, Bartow, V, Curtis, ME, Fishe, J, Webb, K, Norse, A. RE-AIM Evaluation of an ED Pain Coaching Program. Society for Academic Emergency Medicine 2023. Austin, TX. May 2023. https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14718
Motov SM, Khan AN. Problems and barriers of pain management in the emergency department: Are we ever going to get better? J Pain Res. 2008 Dec 9;2:5-11. PMID: 21197290; PMCID: PMC3004630.
National Center for Complementary and Integrative Health. (2024, January 4). 2016 Strategic Plan Exploring the Science of Complementary and Integrative Health. https://files.nccih.nih.gov/s3fs-public/NCCIH_2016_Strategic_Plan.pdf
Pain Assessment and Management Initiative (2024, January 4). https://pami.emergency.med.jax.ufl.edu/
R Core Team (2023). R: A Language and Environment for Statistical Computing. R Foundation for statistical. Computing, Vienna, Austria. https://www.R-project.org/.
Rondon-Ramos A, Martinez-Calderon J, Diaz-Cerrillo JL, Rivas-Ruiz F, Ariza-Hurtado GR, Clavero-Cano S, Luque-Suarez A. Pain Neuroscience Education Plus Usual Care Is More Effective Than Usual Care Alone to Improve Self-Efficacy Beliefs in People with Chronic Musculoskeletal Pain: A Non-Randomized Controlled Trial. J Clin Med. 2020 Jul 11;9(7):2195. doi: 10.3390/jcm9072195. PMID: 32664552; PMCID: PMC7408875.
Presenting Author
Megan E. Curtis
Poster Authors
Megan Curtis Gonzalez
PhD
University of Florida College of Medicine - Jacksonville
Lead Author
Sophia Sheikh
MD
University of Florida College of Medicine - Jacksonville
Lead Author
Magda Montague
MPH
University of Florida College of Medicine – Jacksonville
Lead Author
Michelle Lott
BSH
University of Florida College of Medicine – Jacksonville
Lead Author
Nolan Menze
BSH
University of Florida College of Medicine – Jacksonville
Lead Author
Leighton Cleveland
BSH
University of Florida College of Medicine – Jacksonville
Lead Author
Katelyn Perl
MS
University of Florida College of Medicine – Jacksonville
Lead Author
Amy Crisp
PhD
University of Florida College of Medicine – Jacksonville
Lead Author
Robin Moorman Li
PharmD
University of Florida College of Medicine – Jacksonville
Lead Author
Phyllis Hendry
MD
University of Florida College of Medicine – Jacksonville
Lead Author
Topics
- Education