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Managing chronic pain

(February 24, 2000, Gazette)

These are some of the people involved in an MRC-funded research project to evaluate the Chronic Pain Self-Management Program. Front (L-R): VON nurses Gwynneth Jones (Gander), Maxine Noseworthy (Corner Brook), Robin Fudge (Gander), Lorraine Humber (Corner Brook), Sheila Dominaux (St. John’s) and Judith Legge (St. John’s). Back L-R: Jodi Durdle, Newfoundland project manager; Leah Thorne, workshop consultant; Marjorie Hammond, Ontario project manager; Karen Webber, project co-investigator; Dr. Judy Watt-Watson, co-principal investigator; and Dr. Sandra LeFort, principal investigator.

By Sharon Gray

A newly-funded nursing research project may help the 17 per cent of adults in Canada who live with chronic pain. Dr. Sandra LeFort, Nursing, has developed a low-cost education program called the Chronic Pain Self-Management Program and she’ll be evaluating its effectiveness over the next three years with the help of $340,647 from the Medical Research Council of Canada.

Dr. LeFort said a number of collaborations are involved in order to proceed with the delivery and evaluation of this randomized clinical trial of the program. Twelve nurses from the Victorian Order of Nurses (VON) are currently being trained to deliver the six-week program in three areas of Newfoundland — St. John’s, Gander/Grand Falls and Corner Brook — and at several Toronto and area sites. They will then offer the program to 286 individuals and all individuals will be followed for 12 months to assess the impact of the program on their quality of life and on health service and cost.

To evaluate the effectiveness of the program, Dr. LeFort is working with colleague Karen Webber and research assistant Jodi Durdle at the School of Nursing. She is also collaborating with researchers at the University of Toronto — Dr. Judith Watt-Watson, Nursing, and Dr. Peter Coyte, a health care economist.

Dr. LeFort developed the Chronic Pain Self-Management Program for her doctoral work at McGill University in 1994, and subsequently did a randomized clinical trial of it in the St. John’s area. It is designed for people who suffer from pain not due to arthritis, such as back pain. “I found that people who participated in the program, as opposed to those who did not, were better able to manage their pain. They had perceptions of improved well-being and a better sense of control.”

Although the program had good outcomes, Dr. LeFort wanted to evaluate it further. For one thing, she is the only one so far who has delivered the program and she wants to ensure that a short training program can enable any qualified nurse to manage the 12 hour program, usually delivered over six weeks. Furthermore, she followed the people in her groups for only three months, and she wants to look at whether the intervention makes a difference in the long run. “To do this you really need to do a year-long evaluation.”

A new aspect of the MRC-funded research study is an economic evaluation. “There is very little data on the cost of chronic pain to the individual and to the health care system,” explained Dr. LeFort. “The most common variable is whether the person returns to work, but what we want to look at is the cost of medication, supplies, equipment, health care appointments and work that the person has to pay to have done for them because of their chronic pain problem. There are other associated costs like time off work, time out during the day to go and rest, or the time a partner or friend might take to do something for the person.”

Ms. Webber is conducting the qualitative research component of the study and will be interviewing the nurses who acted as program facilitators as well as analyzing data collected during the delivery of the program. She said that the economic and cost information will be collected by means of a monthly diary that will be kept by participants.
Dr. LeFort said the strength of the Chronic Pain Self-Management Program is that participants are involved in working out their own problems. “They have to figure out what works best for them; it’s not prescriptive but provides them with different options. It’s built a lot around the idea of consistent exercise, and getting people to start moving is important. We teach a very gentle exercise program in the six weeks, an eight-minute flexibility program that incorporates relaxation and deep breathing.”

For further information about the Chronic Pain Self-Management Program, e-mail jdurdle@ morgan.ucs.mun.ca or phone (709) 737-5178.