Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS)

This is the final version of the article. Available from the publisher via the DOI in this record.Background: Chronic musculoskeletal pain is a common problem that is difficult to treat.\udSelf-management support interventions may help people to manage this condition better; however, there\udis limited evidence showing that they improve clinical outcomes. Our overarching research question was\ud‘Does a self-management support programme improve outcomes for people living with chronic\udmusculoskeletal pain?’.\udAim: To develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically\udgrounded self-management support intervention for people living with chronic musculoskeletal pain.\udMethods: In phase 1 we carried out two systematic reviews to synthesise the evidence base for\udself-management course content and delivery styles likely to help those with chronic pain. We also\udconsidered the psychological theories that might underpin behaviour change and pain management\udprinciples. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in\udSelf-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session\udafter 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with\udexperience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the\udliterature on potential outcome domains and measures and consulted widely with patients, tutors and\udexperts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English\udand, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community.\udIn phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of\udadding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain\udtoolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and\udmusculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire.\udWe collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs,\udhealth utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression\udScale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by\udparticipants were extracted from NHS electronic records.\udResults: We recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white\udand 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and\udanxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants\udreceived 85% of the course content. At 12 months there was no difference between treatment groups in\udour primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence\udinterval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration\udall improved more in the intervention group at 6 months. At 1 year these differences remained for\uddepression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS\udintervention had a high probability (87%) of being cost-effective compared with usual care at a threshold\udof £30,000 per quality-adjusted life-year.\udConclusions: Although the COPERS intervention did not affect our primary outcome of pain-related\uddisability, it improved psychological well-being and is likely to be cost-effective according to current\udNational Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a\udsubstitute for less well-evidenced (and more expensive) pain self-management programmes. Effective\udinterventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.The project was funded by the National Institute for Health Research Programme Grants for\udApplied Research programme and will be published in full in Programme Grants for Applied Research;\udVol. 4, No. 14. See the NIHR Journals Library website for further project information