Monika M. Safford
A peer-delivered, cognitive behavioral therapy-based intervention improved functioning, pain, quality of life and self-reported physical activity in patients with diabetes and chronic pain, researchers reported in Annals of Family Medicine.
Monika M. Safford, MD, professor of medicine at Weill Cornell Medicine, told Healio Primary Care that the new findings build on a previous diabetes self-management trial in which a diabetes intervention was delivered by peer coaches. However, many participants in that program could not meet their exercise goals because they were in too much pain. Safford explained that the intervention did not include advice for patients about how to exercise while experiencing chronic pain, nor did it include nonmedicinal approaches to pain management.
“In exploring nonmedication options, we read with great interest a study conducted in Pakistan that delivered a cognitive behaviorial training intervention, delivered by lay health workers similar to our peer coaches, designed to prevent postpartum depression,” she explained. “The intervention reduced depression by 50%. This is very different than our setting, but cognitive behavioral therapy has been widely used to treat pain.”
The Pakistani study consisted of 463 women between the ages of 16 and 45 years in their third trimester of pregnancy that showed signs of perinatal depression. Researchers used CBT techniques of listening actively to these patients, collaborating with family, determining the family’s health beliefs, encouraging alternative ideas and putting what has been learned into practice between sessions to improve maternal depression and infant outcomes.
Safford and colleagues adapted the Pakistani study’s principles to create an eight-session, 3-month long program in a part of Alabama with a high chronic disease burden and a shortage of health care workers. The program focused on healthy eating, physical activity, stress management, communication with health care providers and social support. Each session lasted between 30 and 60 minutes. Peer coaches — trained community members who also provided emotional and practical support for chronic disease management and prevention — delivered the intervention via telephone to 96 participants. Another 99 participants who received a peer-delivered general health advice program served as the control cohort.
Safford and colleagues found that, compared with controls, the intervention participants had greater improvement in functional status (–10 ± 13 vs. –5 ± 18; P = .002) and pain (–10.5 ± 19 vs. –4.8 ± 21; P = .01) as measured by the Western Ontario and McMaster Universities Osteoarthritis Index. The intervention participants also had greater quality of life (4.8 ± 8.8 vs. 3.8 ± 8.8; P = .001) as measured by Short Form 12. Though HbA1c levels, systolic BP and BMI levels did not change significantly in either group, a greater proportion of intervention than control participants reported no pain or did other forms of exercise (eg, chair exercises) when pain prevented them from walking for exercise.
“The population in Alabama loved this!” Safford said. “Cognitive behaviorial training really works to help people become more functional despite pain. Setting small goals and working with a supportive coach can work wonders.” – by Janel Miller
Andreae SJ, et al. Ann Fam Med. 2020;doi:10.1370/afm.2469.
Rahman A, et al. Lancet. 2008;doi:10.1016/S0140-6736(08)-61400-2.
Disclosures: The authors report no relevant financial disclosures.