Background & Aims

Internet-based treatment programs present a solution for providing access to pain management for those unable to access clinic-based multidisciplinary pain programs. Pain research often focuses on populations with one site of pain, and those with complex presentations are often excluded despite the fact that up to 85% of the chronic pain population report multi-site pain (1-3). Increasing complexity, including the number and area of body regions of pain, has a negative impact on outcomes(1,-3). To develop online programs that are patient centred and effective, there is a need to understand the population so that programs can offer the best option to fit the person with pain. Reboot online was the first multidisciplinary online pain program and has been shown to be effective and scalable (4,5). The aim of this study was to investigate the body regions and evaluate the influence of number of pain sites on clinical outcomes in participants of “Reboot online” to inform future development.

Methods

Study design: An observational, cross-sectional study design

Study setting: THIS WAY UP (thiswayup.org.au) online programs

Participants
Participants enrolled in “Reboot online”
>18 years
Chronic pain as diagnosed by referring clinician
Access to internet and computer

Between 2017-2021, 2002 people with chronic pain enrolled in Reboot Online and completed a suite of validated outcome measures: K-10 (6), PHQ-9 (7), BPI (8), TSK (9), PSEQ (10), PDI (11). The specific regions and number of regions of pain were evaluated using Question 1 of the BPI by coding for nine body regions: lower limb, lumbar spine, abdominal, trunk/thoracic spine, pelvis, upper limb, cervical spine, headache/head and face. Participants were categorised into 4 groups according to the number of body regions of pain: 1, 2, 3 or >3. One way analysis of variance was conducted to explore differences between the number of body regions and baseline outcome measures.

Results

Participants had a mean age of 48.56 years ± 14.35, ranging from 18-90 years and were predominantly female (n=1351, 67%). The most frequent region of pain was lumbar spine (n=1401, 70%) followed by lower limb (n=1258, 64%) and upper limb (n=865, 43%). The mean number of locations of pain was 2.66 ± 1.41 (mean ± standard deviation). Mean differences between those with 1 body region of pain vs >1 body regions of pain were statistically significant (p < .05) for all outcomes except the TSK. There was no significant difference between those with 2 body regions of pain and 3 body regions of pain.

Conclusions

The prevalence of multiisite pain is high amongst persons enrolled in the online pain management program “Reboot online”. An increase in the number of body regions reported was associated with poorer psychosocial health. Interestingly, kinesiophobia scores were not significantly impacted by an increase in the number of body regions of chronic pain. Future research in pain treatments should include multisite pain to better reflect the clinical population. Research should investigate the effect of number of body regions of pain on the efficacy of pain interventions and explore the need for stratifed care based on the number of body regions, to suit the individual’s presentation.

References

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2. Kamaleri, Y., Natvig, B., Ihlebaek, C. M., & Bruusgaard, D. (2008). Localized or widespread musculoskeletal pain: Does it matter? Pain (Amsterdam), 138(1), 41–46. https://doi.org/10.1016/j.pain.2007.11.002
3. Carnes, D., Parsons, S., Ashby, D., Breen, A., Foster, N. E., Pincus, T., Vogel, S., & Underwood, M. (2007). Chronic musculoskeletal pain rarely presents in a single body site?: results from a UK population study. Rheumatology (Oxford, England), 46(7), 1168–1170. https://doi.org/10.1093/rheumatology/kem118
4. Smith, J., Faux, S. G., Gardner, T., Hobbs, M. J., James, M. A., Joubert, A. E., Kladnitski, N., Newby, J. M., Schultz, R., Shiner, C. T., & Andrews, G. (2019). Reboot Online: A Randomized Controlled Trial Comparing an Online Multidisciplinary Pain Management Program with Usual Care for Chronic Pain. Pain Medicine, 20(12), 2385-2396. https://doi.org/10.1093/pm/pnz208
5. Shiner, C. T., Gardner, T., Haskelberg, H., Li, I., Faux, S. G., Millard, M., & Mahoney, A. E. J. (2022). The Uptake and Effectiveness of a Multidisciplinary Online Program for Managing Chronic Pain before and During the COVID-19 Pandemic. Pain Medicine, 23(9), 1621-1630. https://doi.org/10.1093/pm/pnac049
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Presenting Author

Tania Gardner

Poster Authors

Tania Gardner

PhD, BAppSc (Physiotherapy)

University of Sydney

Lead Author

E-mail

Topics

  • Access to Care

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