P-049 - The Effect of a Brief Action Planning Telephone Intervention in Patients with Chronic Pain

Abstract Title: The Effect of a Brief Action Planning Telephone Intervention in Patients with Chronic Pain

Background: Patient self-management of chronic pain is an important part of overall pain care but behavior change is difficult. Brief action planning (BAP) is a structured technique that providers can use to support patient self-management (Gutnick et al., 2014) based on the principles of motivational interviewing, but BAP is designed to be more readily implemented by clinicians of various disciplines.



BAP consists of asking three simple questions: 1. "Is there anything you would like to do for your health in the next week or two?" 2. "How confident or sure do you feel about carrying out your plan (on a scale from 0-10)?" 3. "Would it be helpful to set up a time to check on how things are going with your plan?" and incorporates five skills to guide patients to set a goal and make an action plan. A detailed explanation of how to implement BAP can be found in Gutnik et al. 2014 and https://centrecmi.ca/brief-action-planning/.



Though there is increasing interest in the use of BAP in medical settings (e.g., Jadotte et al., 2023) and case reports supporting its use in chronic pain (e.g., Connell et al., 2020), more research is needed to confirm its effectiveness.

Purpose/Objectives: The purpose of this study is to evaluate the effectiveness of a brief action planning telephone intervention in a sample of patients with chronic pain when used as an adjunct to standard treatment within a pain management clinic. Using an attention control condition for comparison, we hypothesize that patients in the BAP intervention group will report reduced pain severity, pain interference, depression and anxiety, and improved self-efficacy following the intervention at Time 2. The secondary aim is to examine for whom the treatment works best. Follow up analyses will examine if the intervention worked differently by age, sex, race, and education level.

Methods: Participants with chronic pain (N = 172: Mean Age 58; 74% female; 59% Black and 30% White; 55% some college or more, 45% high school or less) were recruited from the waiting room of an urban pain management clinic. Using a quasi-experimental design, participants were assigned to a BAP intervention or an attention control (ATT) group. Both groups continued to receive their usual pain treatment. A master’s level clinician telephoned patients to deliver BAP and help them set a goal and action plan and then checked progress during calls 2 and 4 weeks later. The ATT group received calls checking in on mood and pain at the same time points. BAP phone calls took an average of 5 minutes to complete and patients tended to self-generate active goals (e.g., walking, doing physical therapy exercises, cleaning, changing diet). Time 1 measures were collected at recruitment before the intervention and at Time 2 after the last call. Questionnaires assessed demographic variables, pain severity and pain interference (Brief Pain Inventory Short Form; Cleeland, 1991), depression (Patient Health Questionnaire-9; Kroenke et al., 2001), anxiety (Generalized Anxiety Disorder-7; Spitzer et al., 2006) and pain self-efficacy (adapted Arthritis Self-Efficacy Pain Scale; Lorig et al., 1989).

Results: A two-way repeated measures ANOVA with correction for multiple comparisons (p≤.01) was conducted to examine the interaction effect between group (BAP vs. ATT) and time (Time 1 and 2) on dependent variables: pain severity, pain interference, pain self-efficacy, anxiety, and depression. The results indicated significant Group x Time interaction effects for pain severity F(1, 168) = 9.57, p = .002 (MBAP1 = 6.56, SD = 2.09 MBAP2 = 6.14, SD = 2.18 versus MATT1 = 6.56, SD = 2.35 MATT2 = 6.62, SD = 2.39); anxiety, F(1, 157) = 15.89, p < .001 (MBAP1 = 7.01, SD = 6.42 MBAP2 = 5.46, SD = 5.49 versus MATT1 = 7.80, SD = 5.85 MATT2 = 7.71, SD = 5.92); and depression, F(1, 164) = 7.74, p = .006 (MBAP1 = 10.13, SD = 7.18 MBAP2 = 8.21, SD = 7.05 versus MATT1 = 9.33, SD = 5.40 MATT2 = 9.51, SD = 5.30). These results show that participants in the BAP group reported improvements in pain severity, anxiety, and depression over time. There was a main effect for improvement in pain interference and self efficacy over time, but the difference between groups was no longer significant when applying the multiple comparison correction. Additionally, using one-way ANOVA and chi-square tests, changes in the dependent variables from pre- to post-intervention in the BAP group did not vary significantly based on age, education, gender (male and female), race (Black and White), or education level (high school or less and some college or more).

Conclusions/Implications for future research and/or clinical care: Results of this study show that BAP is an effective adjunctive intervention to usual pain treatment. A demographically and medically diverse sample of patients with chronic pain receiving this brief intervention reported lower pain severity, anxiety, and depression over time. Some limitations of this study are the use of a single study therapist and the use of only subjective measures which can also be subject to impression management. Future research should focus on how the effectiveness of BAP varies when delivered in different formats and by different clinicians. However, our study provides support for the use of a brief intervention that supports pain self-management that could be integrated within clinic settings to improve outcomes for patients with chronic pain.

References:

1. Gutnick D, Reims K, Davis C, et al. Brief action planning to facilitate behavior change and support patient self-management. JCOM 2014;21(1):17-29.


2. Centre for Collaboration Motivation & Innovation. Brief Action Planning. Available at: https://centrecmi.ca/brief-action-planning/. Accessed August 1, 2021.


3. Jadotte Y, Buchholz B, Carroll W, Frum-Vassallo D, MacPherson J, Cole S. Brief Action Planning in Health and Health Care: A Scoping Review. Med Clin North Am. 2023;107(6):1047-1096.


4. Connell G, Verville L, Cancelliere C, Wong JJ, Yu H, Shearer HM. Brief action planning targeting prognostic factors for an adult with persistent low back pain without radiculopathy: A case report. Clin Case Rep. 2020;8(12):2777-2781.