Novel three-day, community-based, nonpharmacological group intervention for chronic musculoskeletal pain (COPERS): a randomised clinical trial
Open accessAbstract
BACKGROUND: Chronic musculoskeletal pain is the leading cause of disability worldwide. The effectiveness of pharmacological treatments for chronic pain is often limited, and there is growing concern about the adverse effects of these treatments, including opioid dependence. Nonpharmacological approaches to chronic pain may be an attractive alternative or adjunctive treatment. We describe the effectiveness of a novel, theoretically based group pain management support intervention for chronic musculoskeletal pain. METHODS AND FINDINGS: We conducted a multi-centre, pragmatic, randomised, controlled effectiveness and cost-effectiveness (cost-utility) trial across 27 general practices and community musculoskeletal services in the UK. We recruited 703 adults with musculoskeletal pain of at least 3 mo duration between August 1, 2011, and July 31, 2012, and randomised participants 1.33:1 to intervention (403) or control (300). Intervention participants were offered a participative group intervention (COPERS) delivered over three alternate days with a follow-up session at 2 wk. The intervention introduced cognitive behavioural approaches and was designed to promote self-efficacy to manage chronic pain. Controls received usual care and a relaxation CD. The primary outcome was pain-related disability at 12 mo (Chronic Pain Grade [CPG] disability subscale); secondary outcomes included the CPG disability subscale at 6 mo and the following measured at 6 and 12 mo: anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), pain acceptance (Chronic Pain Acceptance Questionnaire), social integration (Health Education Impact Questionnaire social integration and support subscale), pain-related self-efficacy (Pain Self-Efficacy Questionnaire), pain intensity (CPG pain intensity subscale), the census global health question (2011 census for England and Wales), health utility (EQ-5D-3L), and health care resource use. Analyses followed the intention-to-treat principle, accounted for clustering by course in the intervention arm, and used multiple imputation for missing or incomplete primary outcome data. The mean age of participants was 59.9 y, with 81% white, 67% female, 23% employed, 85% with pain for at least 3 y, and 23% on strong opioids. Symptoms of depression and anxiety were common (baseline mean HADS scores 7.4 [standard deviation 4.1] and 9.2 [4.6], respectively). Overall, 282 (70%) intervention participants met the predefined intervention adherence criterion. Primary outcome data were obtained from 88% of participants. There was no significant difference between groups in pain-related disability at 6 or 12 mo (12 mo: difference -1.0, intervention versus control, 95% CI -4.9 to 3.0), pain intensity, or the census global health question. Anxiety, depression, pain-related self-efficacy, pain acceptance, and social integration were better in the intervention group at 6 mo; at 12 mo, these differences remained statistically significant only for depression (-0.7, 95% CI -1.2 to -0.2) and social integration (0.8, 95% CI 0.4 to 1.2). Intervention participants received more analgesics than the controls across the 12 mo. The total cost of the course per person was £145 (US$214). The cost-utility analysis showed there to be a small benefit in terms of quality-adjusted life years (QALYs) (0.0325, 95% CI -0.0074 to 0.0724), and on the cost side the intervention was a little more expensive than usual care (i.e., £188 [US$277], 95% CI -£125 [-US$184] to £501 [US$738]), resulting in an incremental cost-effectiveness ratio of £5,786 (US$8,521) per QALY. Limitations include the fact that the intervention was relatively brief and did not include any physical activity components. CONCLUSIONS: While the COPERS intervention was brief, safe, and inexpensive, with a low attrition rate, it was not effective for reducing pain-related disability over 12 mo (primary outcome). For secondary outcomes, we found sustained benefits on depression and social integration at 6 and 12 mo, but there was no effect on anxiety, pain-related self-efficacy, pain acceptance, pain intensity, or the census global health question at 12 mo. There was some evidence that the intervention may be cost-effective based on a modest difference in QALYs between groups. TRIAL REGISTRATION: ISRCTN Registry 24426731.
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The CHESS intervention builds on a previously developed and tested educational and cognitive behavioural self-management intervention for people with chronic musculoskeletal pain.
“The intervention builds on a previously developed and tested educational and cognitive behavioural self-management intervention for people with chronic musculoskeletal pain.24”
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Underwood, M. R., Achana, F. A., Carnes, D., Eldridge, S. M., Ellard, D. R., Griffiths, F. E., Haywood, K. L., Hee, S. W., Higgins, H. B., Mistry, D., et al. (2022) · Neurology · doi:10.1212/wnl.0000000000201518 · Cited by 29 · see citing works
“Nonattendance is common in trials of group interventions for chronic pain, for example, 17% and 11% in 2 similar studies.(41,42) The unpredictable nature of headache disorders might explain the higher nonattendance rate in this study.”
BackgroundResultThe Self-Efficacy for Home Exercise Programs Scale: Development and Psychometric Properties
Picha, K. J., Lester, M., Heebner, N. R., Abt, J. P., Usher, E. L., Capilouto, G. J., & Uhl, T. L. (2019) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2019.8779 · Cited by 27 · see citing works
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“24 The aim of the course is to encourage and enable those with chronic headaches to recognise unhelpful thought patterns and behaviours that contribute to their headache burden and to do something about them.”
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Sandhu, H. K., Abraham, C., Alleyne, S., Balasubramanian, S., Betteley, L., Booth, K., Carnes, D., Furlan, A. D., Haywood, K. L., Iglesias-Urrutia, C. P., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-028937 · Cited by 19 · see citing works
Kustra-Mulder, A., Löwe, B., & Weigel, A. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111485 · Cited by 18 · see citing works
on behalf of the CHESS team, White, K., Potter, R., Patel, S., Nichols, V. P., Haywood, K. L., Hee, S. W., Mistry, D., Carnes, D., Taylor, S. J. C., et al. (2019) · BMC Medical Research Methodology · doi:10.1186/s12874-019-0672-5 · Cited by 18 · see citing works
Self-citationScott, L. J., Kesten, J. M., Bache, K., Hickman, M., Campbell, R. M., Pickering, A. E., Redwood, S., & Thomas, K. H. (2019) · British Journal of General Practice · doi:10.3399/bjgp19x707237 · Cited by 18 · see citing works
“…group-based pain management support intervention for chronic musculoskeletal pain (COPERS) was not effective in reducing pain-related disability at 12 months, though benefits were observed for depression and social integration; 39 these results are similar to those found in the presented study.”
Physical Therapists’ Assessment of Patient Self-Efficacy for Home Exercise Programs
Picha, K. J., Valier, A. R. S., Heebner, N. R., Abt, J. P., Usher, E. L., Capilouto, G. J., & Uhl, T. L. (2021) · International Journal of Sports Physical Therapy · doi:10.26603/001c.18957 · Cited by 16 · see citing works
Recruitment and retention for chronic pain clinical trials: a narrative review
Kennedy, N., Nelson, S. J., Jerome, R. N., Edwards, T. L., Stroud, M., Wilkins, C. H., & Harris, P. A. (2022) · PAIN Reports · doi:10.1097/pr9.0000000000001007 · Cited by 14 · see citing works
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“The rationale for this being they can bring their own personal experience to the group-based intervention (Taylor et al., 2016a; 2016b).”
BackgroundPredictors of self-management in patients with chronic low back pain: a longitudinal study
Banerjee, A., Hendrick, P. A., & Blake, H. (2022) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-022-05933-2 · Cited by 13 · see citing works
“These minor benefits of SM programmes are potentially due to several factors, including the lack of targeted SM interventions for specific populations [23].”
BackgroundUnderwood, M. R., Achana, F. A., Carnes, D., Eldridge, S. M., Ellard, D. R., Griffiths, F. E., Haywood, K. L., Hee, S. W., Higgins, H. B., Mistry, D., et al. (2023) · Programme Grants for Applied Research · doi:10.3310/pljl1440 · Cited by 10 · see citing works
Gordon, K. S., Peduzzi, P. N., & Kerns, R. D. (2020) · Pain Medicine · doi:10.1093/pm/pnaa347 · Cited by 10 · see citing works
“For example, some studies we reviewed may not be considered highly pragmatic on the basis of their exclusion of patients with serious medical conditions and/or mental health and substance use disorders [17].”
BackgroundInfluentialKesten, J. M., Thomas, K. H., Scott, L. J., Bache, K., Hickman, M., Campbell, R. M., Pickering, A. E., & Redwood, S. (2019) · British Journal of General Practice · doi:10.3399/bjgp19x706097 · Cited by 9 · see citing works
“62 The findings from the current service suggest that prolonged engagement helps enhance service acceptability, which in turn could support improved outcomes.”
Wilson, M. V., BRAITHWAITE, F., Arnold, J. B., Crouch, S. M., Moore, E., Heil, A. M., Cooper, K., & Stanton, T. R. (2024) · Pain · doi:10.1097/j.pain.0000000000003293 · Cited by 8 · see citing works
Pain coping skills training un-locks patient-centered pain care during the COVID- 19 lockdown
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The Economic Utility of Clinical Psychology in the Multidisciplinary Management of Pain
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“A group treatment for musculoskeletal pain sufferers based on cognitive behavioral principles resulted in additional 0.0325 Quality Adjusted Life Years (QALY) with respect of the control condition, with an incremental cost per QALY of £5,786 (Taylor et al., 2016).”
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Peoples’ experiences of painful diabetic neuropathy: are pain management programmes appropriate?
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“Moreover, studies have reported mainly from group-based interventions in primary care [19] or rehabilitation settings [12, 20].”
BackgroundWilhelm, E. A., Soares, P. S., dos Reis, A. S., Barth, A., Freitas, B. G., da Motta, K. P., Lemos, B. B., Vogt, A. G., da Fonseca, C. A. R., Araujo, D. R., et al. (2019) · Pharmacological Reports · doi:10.1016/j.pharep.2019.07.003 · Cited by 5 · see citing works
Factors Associated to Medication Consumption Among the Immigrant Population Residing in Spain
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“This may be associated with the appearance of psychosomatic symptomatology of migratory grief [37], such as depression and anxiety states [38], and could be associated with chronic migration stress, also called Ulysses syndrome [39], which takes time to get over and sometimes worsens because of settlement circumstance…”
BackgroundCommunity programme reduces depression in patients with chronic pain, study shows
Mayor, S. (2016) · BMJ · doi:10.1136/bmj.i3352 · Cited by 3 · see citing works
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“MSK disorders not only restrict physical function and mobility, but also impair patients’ psychological well-being and quality of life [9, 10].”
Witziers, B. (1996) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 2 · see citing works
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“…care interventions included individualized care plans, occupational therapy-led programs, home safety modifications, assistive device provision, caregiver-involved programs, palliative and supportive care, and self-management support for chronic conditions (13, 69–71, 76–78, 91, 93, 96, 103, 104).”
InfluentialVicente, A., Coelho, A., Lobão, C. A. R. F., Gonçalves, R., & Parola, V. S. D. O. (2022) · Enfermería actual en Costa Rica · doi:10.15517/enferm.actual.cr.v0i43.47876 · Cited by 1 · see citing works
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“This was evident in participants' ambiv-alent narratives regarding their pain experience, and other research indicates similar findings (Taylor et al., 2016).”
Therapeutic alternatives for supporting GPs to deprescribe opioids: a cross-sectional survey
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BackgroundInfluentialWhy Do Patients With Systemic Lupus Erythematosus Suffer Pain?
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“Such programmes have the advantage of being safe and inexpensive and can be delivered to large numbers of people in the community, though it is often difficult to show statistically significant effects on pain intensity or interference(17).”
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“…(1) randomized trials in which noncompliance is either permitted or unavoidable, e.g., the FILMS trial (Lois et al., 2008) and the COPERS trial (Taylor et al., 2016), (2) natural experiments, e.g., the OHIE in Section 5, and (3) encouragement experiments, e.g., the moving to opportunity for…”
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- Authors
- Taylor, S. J. C., Carnes, D., Homer, K., Kahan, B. C., Hounsome, N., Eldridge, S., Spencer, A., Pincus, T., Rahman, A., & Underwood, M.
- Affiliations
- Queen Mary University of London (GB)
- University of Exeter (GB)
- Royal Holloway University of London (GB)
- University College London (GB)
- University of Warwick (GB)
- Corresponding author
- Taylor, Stephanie J. C.
- ORCID
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-06-14
- Volume
- 13
- Issue
- 6
- Pages
- e1002040
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC4907437
- OpenAlex
- W2309126213
- Cited by
- 63
- References
- 50
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 9 · 2019: 10 · 2018: 4 · 2017: 6 · 2016: 1
- FWCI
- 5.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- ePrints Soton (University of Southampton) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
- Warwick Research Archive Portal (University of Warwick) (submittedVersion)
- Funders
- National Institute for Health Research (RP-PG-0707-10189)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic musculoskeletal pain, non-pharmacological pain management, cognitive behavioral therapy, pain self-efficacy, pain-related disability, pain acceptance, anxiety and depression, social integration, health-related quality of life, cost-effectiveness, community-based intervention, general practice, opioid use disorder, copers, EQ-5D-3L, health care utilization
- MeSH terms
- Adult, Aged, Community Health Services, Cost-Benefit Analysis, Female, United Kingdom, Humans, Male, Middle Aged, Quality of Life, Time Factors, Treatment Outcome, Chronic Pain, Musculoskeletal Pain
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