PainTRAINER Program Improves Outcomes for Patients With Systemic Lupus Erythematosus

The painTRAINER program included 8 weekly modules, in addition to coping skill activities, in which investigators measured outcomes including the Pain Catastrophizing Scale, pain interference, physical function, anxiety and depression, fatigue, and sleep disturbances.

The painTRAINER program reported improvements for patients with systemic lupus erythematosus (SLE) in physical and psychological outcomes, according to BMC.1 While pain coping skills training (PCST) have shown potential benefit in this patient population, investigators believe strategies need to be put in place to improve engagement rates and aid in customization for specific symptoms and challenges.

“Patients with SLE often experience pain and other symptoms that negatively impact quality of life. Interventions that enhance the use of behavioral and cognitive coping strategies may lead to improved outcomes among patients with SLE,” stated investigators. “PCST programs have been shown to improve outcomes among patients with other rheumatic conditions, but there have been no trials of PCST among patients with SLE. This study was a preliminary assessment of the feasibility and efficacy of painTRAINER, an automated, internet-based PCST program, among patients with SLE.”

A total of 60 patients with SLE were assigned to either the painTRAINER program or a control group. The internet-based program included 8 weekly modules in addition to coping skill activities, which took approximately 30-45 minutes to complete. Investigators measured outcomes at baseline and after the 8-week program, including the Pain Catastrophizing Scale (focusing on and exaggerating pain and one’s ability to deal with pain), pain interference, physical function, anxiety and depression, fatigue, sleep disturbances, and a LupusPRO questionnaire.

Data was collected via telephone and follow-ups were conducted by blinded study team members. Eligible patients were found within the University of North Carolina at Chapel Hill (UNC) Health Care System.

Patients rated their current pain on a 0-10 scale (with a minimum score of 4 for inclusion) and completed baseline assignments before being randomized into the 2 cohorts. A patient’s pain was analyzed by how it impacted social, cognitive, emotional, physical aspects of life, as well as recreational activities.

The secondary outcomes were determined using the coping strategies questionnaire and the LupusPRO questionnaire, which focused on self-reported coping strategies, such as coping self-statements, and lupus-related symptoms and medication usage.

In the painTRAINER cohort, approximately 50% accessed the program. Participants reported issues with not receiving instructions via email. Positive feedback included the flexibility of the program, however, many noted that the descriptions of pain were not always accurate for patients with SLE. Despite some critical feedback, those in the painTRAINER group had better improvements in PROMIS Pain Interference, Depression scores, PROMIS sleep disturbance, anxiety, fatigue, and Quality of Life Scores when compared with the control group. Both groups had decreased PROMIS Physical Function scores.

Limitations included generalizability, as the pilot was quite small and participants were selected from a singular medical center. Additionally, as painTRAINER was a free program, there is a small chance that the control cohort were also utilizing the program during the study period.

“Our next step to address this is to work with patient stakeholders to develop strategies for incorporating SLE-related content into painTRAINER,” concluded investigators. “Although the convenience of the online painTRAINER format was very appealing to participants in this study, adding the support and accountability of participating in the program alongside others may boost engagement and efficacy. Therefore, our study team and patient stakeholders will consider potential real-time delivery strategies within the study design.”

Reference:

Allen KD, Beauchamp T, Rini C, et al. Pilot study of an internet-based pain coping skills training program for patients with systemic Lupus Erythematosus. BMC Rheumatol. 2021;5(1):20. Published 2021 Jun 17. doi:10.1186/s41927-021-00191-6