Background & Aims
Patients with chronic neuropathic pain present severe disability and a low quality of life because pharmacological therapies are often inadequate and poorly tolerated.
Recently, the literature shown how educational support and use of behavioral approaches can be helpful for this category of patients when combined with specific pharmacological prophylaxis. Mindfulness is considered an effective approach for helping patients to being more conscious about their condition, to enforce the ability to cope with pain and to manage their pain without or more less medications. Usually, the behavioral approach with mindfulness is delivered with weekly, face-to-face sessions. Due to COVID-19 emergency our treatment protocol was modified, reducing face-to-face visits, taking advantage of technologies facilities.
Aim of this study is to assess the feasibility and
effectiveness of a specific protocol, designed during the COVID-19 emergency, consisting of a specific behavioral program
Methods
Patients were enrolled after a clinical evaluation at the IRCCS Foundation “Carlo Besta ” Neurological Institute. Pharmacological treatment and behavioral approach were proposed to patients. Mindfulness sessions were performed online by a specific web platform with one-hour-weekly group-sessions, leaded by a mindfulness expert, alongside daily standardized mindfulness 12-minutes sessions on their smartphone; face-to-face visits every three months were scheduled up to one-year. We assessed: pain intensity and medication intake, catastrophizing (PCS), depression (BDI) and self-efficacy perception (GSE) at the beginning of treatment and at 3 and 6 months follow-up.
Results
Thirty-six patients were enrolled. Mean age 45.5±13.5y; onset of disease 37.6±16y; age at pain chronification 39.9±14.4y. Pain intensity and medication intake did not change significantly; questionnaire results: GSE (pretreatment 27.2±5.0 vs 26.6±5.3 at 3 months vs 29±5.36). BDI
(16.2±8.8 pretreatment vs 12±7.7 at 3 months vs 12.5±10.2 at 6 months), PCS (28.4 ±10.8 pretreatment vs 23 ±11 at 3 months vs 21.7±10.8 at 6 months).
Conclusions
Our results did not show any change in clinical indexes at 6 months; a slight decrease in PCS and BDI were recorded. GSE did not change significantly. Patients’ adherence was high, improving treatment
compliance and, although not specifically assessed, increasing their ability to cope with pain and to tolerate drug-treatment. The result, although preliminary, confirm that the use of technological is effective and feasible to deliver behavior approach, allowing more patients to access to this program.
References
– Eccleston C, Blyth F, Dear B, et al (2020) Managing patients with chronic pain during the COVID-19 outbreak: considerations for the rapid introduction of remotely supported (eHealth) pain management services. PAIN 161; 5: 889-893
– Grazzi L, Telesca A, Rizzoli P. Management of chronic migraine with medication overuse by web-based behavioral program during the COVID-19 emergency: results at 12 months. Neurol Sci. 2022 Mar;43(3):1583-1585. doi: 10.1007/s10072-021-05836-5. Epub 2021 Dec 21. PMID: 34932161; PMCID: PMC8689283.
– Linardon J (2020) Can acceptance, mindfulness and self-compassion be learned by smartphone and apps? A systematic meta-analytic review of randomized controlled trials. Behavior Therapy 51: 646-658
Presenting Author
Alessandra Telesca
Poster Authors
Alessandra Telesca
PhD candidate
IRCCS Foundation “Carlo Besta " Neurological Institute
Lead Author
Monica Consonni
Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano
Lead Author
Antonio Danilo Montisano
IRCCS Foundation “Carlo Besta " Neurological Institute
Lead Author
Eleonora Dalla Bella
IRCCS Foundation “Carlo Besta " Neurological Institute
Lead Author
Licia Grazzi
IRCCS Foundation “Carlo Besta " Neurological Institute
Lead Author
Topics
- Treatment/Management: Complementary and Alternative therapies