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Empowered Waiting: Building a Virtual Program that Supports Chronic Pain Care

The impact that chronic pain has on quality of life is well known. Having significant effects on a person’s physical and mental health, it is not always easy to quickly identify the comprehensive care needed for this at times complex condition. Today chronic pain, which is defined as pain that persists or recurs for more than three months, is recognized as a disease in its own right. Yet despite this knowledge, wait times for persons with chronic pain to receive treatment in Canada can currently range from six months to two and a half years, depending on the program or referred service. Such lengthy periods of waiting to receive care can lead to further deteriorations in health, functioning and quality of life. While reducing wait times is critical to improving chronic pain management and care, School of Nursing faculty member Dr. Rosemary Wilson and the interprofessional health research team she co-leads have decided to turn these wait times into an opportunity—implementing accessible interventions that improve psychosocial functions and support people’s abilities to actively manage their condition.

The treatment of chronic pain usually requires a multi-pronged approach that incorporates not just medication and non-pharmacological therapies, but also self-management activities like modified exercises, mindfulness, lifestyle modification and pain education. In fact, self-management is widely recognized by clinicians as critical to improving self-efficacy and functional outcomes for chronic pain sufferers, while reducing healthcare costs. "When we know that fewer than 50% of people report that they are ready to change their behaviors at the start of treatment, capitalizing on the wait time to improve readiness and self-management just makes good sense" says Dr. Wilson.

That’s where the teams’ "Empowered Management" research project comes in. Its a feasibility study designed to get a better sense of how practical it is for patients living with chronic pain to follow an online program designed to enhance their readiness for change and build the self-management skills they will need to work with health teams at chronic pain clinics. The program is comprised of self-directed modules and learning activities with coaching support. Delivered virtually by health providers, the coaching sessions focus on increasing motivation and commitment to change by exploring and resolving uncertainty and ambivalence. The online educational modules were developed and reviewed in partnership with clinical experts and persons living with chronic pain.

"The ultimate goal is to equip those we care for with the knowledge and the motivation they need to fully engage with and reap the benefits of their care plan" says Dr. Rosemary Wilson, who co-leads the interprofessional research team with Dr. Rachael Bosma (Toronto Academic Pain Management Institute/University of Toronto). “We are excited to trial a virtual method of delivering the program, to prepare persons for interdisciplinary chronic pain care.”

Study recruitment is approaching completion, with participants selected from two chronic pain clinic waitlists in Ontario: one based in Kingston and one in Toronto. Outcomes are assessed pre- and post-intervention and will guide the implementation of this program at a larger scale in the future. While the project’s original timeline has been impacted by the pandemic, Dr. Wilson sees a renewed importance in finding ways to use the often growing wait times within the Canadian health system. “Our experience with the COVID-19 pandemic has reaffirmed the need to be creative in providing care in different ways; engaging people awaiting care is innovative and efficient and the virtual platform increases access”.

Watch Dr. Wilson's and patient partner Lynn Cooper's presentation regarding this work at the School of Nursing's Academic Series:

To learn more about other exciting research projects happening at the School of Nursing, please visit our nursing and health research website and read our most recent research report