key: cord-0050376-y13ucbpw
authors: Yih, Erika T.; Silver, Julie K.
title: Letter to the Editor on “Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial”
date: 2020-09-19
journal: Arch Phys Med Rehabil
DOI: 10.1016/j.apmr.2020.06.032
sha: 21f24402c8ea28b092e8f535dd1d03f9f8d62ba8
doc_id: 50376
cord_uid: y13ucbpw

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Letters to the Editor Letter to the Editor on "Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial"

We were very interested to read about Miller et al's unique selfmanagement support (SMS) program for patients with chronic noncancer pain, described in their article "Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial." 1 As the authors point out, chronic pain is a leading contributor to disability, health care utilization, and reduced workplace productivity. Many individuals with chronic pain suffer from multiple comorbidities and have significant barriers to accessing health care. Yet, this population is underrepresented in pain research, whether directly owing to exclusion criteria in many studies or indirectly owing to selection bias in recruitment methods. This article is unique in that it draws its subjects from a community health center serving a marginalized population, including people with low income, lack of health insurance, addiction or mental health concerns, and isolated seniors. The SMS intervention developed by the authors is also unique in its inclusion of tailored exercise regimens for each individual, as well as cognitive behavioral strategies targeting cognitive risk factors for chronic pain.

The COMMENCE intervention described in Miller et al's article consisted of 2 visits per week over 6 weeks. One weekly group meeting focused on education about self-management, pain science, and cognitive behavioral principles. Another weekly individual meeting between the patient and a physical therapist helped support implementation of self-management plans and develop an individually tailored exercise program. With a patient population that has multiple comorbidities and barriers to health care, it is impressive that more than half of the participants in the intervention group attended at least 75% of the sessions. We were impressed by their improvements in outcomes measuring function, pain intensity, catastrophic thinking, and self-efficacy, among others.

Keeping in mind that some of the barriers to health care may be related to transportation and the logistics of traveling for in-person visits, we wonder whether such an intervention could be delivered remotely with a similar level of efficacy, especially with the increase in telemedicine applications in response to the coronavirus disease pandemic. In a systematic review of digital support interventions for the self-management of low back pain, Nicholl et al 2 found heterogenous studies in the literature but noted that most of the interventions did not include a physical activity component and several did not have tailoring elements, both areas in which COMMENCE excels. Although we recognize that remote delivery may present technological barriers, it might also allow the intervention to reach a population that could not feasibly participate in the in-person program. In addition, the convenience of remote delivery could facilitate longer term participation and maintenance of the resulting benefits.

We applaud Miller et al for their research focused on filling a need for patients with chronic pain, multimorbidity, and barriers to health care access. We look forward to further work on the important topic of SMS in chronic pain management and hope that telemedicine applications will have a role for expanding the audience for SMS interventions.

Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for people with chronic pain and multiple comorbidities: a randomized controlled trial

Digital support interventions for the self-management of low back pain: a systematic review

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