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Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS)
Open accessAbstract
Background: Chronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’. Aim: To develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain. Methods: In phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records. Results: We recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year. Conclusions: Although the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed. Trial registration: Current Controlled Trials ISRCTN22714229. Funding: The project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research ; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.
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“Our previous experience is that the challenges of running non-English language group interventions for chronic painful disorders are too great to do successfully within an RCT.22”
From Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: A randomised controlled trial protocol (CHESS) (2020) · cites this paper as [22]
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“HADs has been used in many previous studies of chronic pain, including the COPERS (Coping with persistent Pain, Effectiveness Research into Self-management) study where we identified positive effects on both anxiety and depression in a chronic pain population.22 34”
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Nicholl, B. I., Sandal, L. F., Stochkendahl, M. J., McCallum, M., Suresh, N., Vasseljen, O., Hartvigsen, J., Mork, P. J., Kjær, P., Søgaard, K., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7290 · Cited by 190
“In addition, these reviews have suggested that future studies should extend the outcomes of interest to include aspects of self-efficacy, and also consider the impact of the duration of the intervention [13,40], increase the length of follow-up [16], and also consider the impact of such interventions on health care ut…”
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“The demography of the study participants was: 67% female, mean age 60 years (52 years in London and 67 in Midlands) and 81% white British.”
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On behalf of the CHESS team, Patel, S., Potter, R. C., Matharu, M. S., Carnes, D., Taylor, S. J., Nichols, V. P., Pincus, T., Underwood, M. R., & Sandhu, H. K. (2019) · The Journal of Headache and Pain · doi:10.1186/s10194-019-0980-5 · Cited by 37
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Self-citationFu, Y., McNichol, E., Marczewski, K., & Closs, S. J. (2018) · Qualitative Health Research · doi:10.1177/1049732318768229 · Cited by 24
“, 2013; Henshall, Greenfield, & Gale, 2017) and cost-effective (Taylor et al., 2016).”
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Muschalla, B. (2017) · European Journal of Work and Organizational Psychology · doi:10.1080/1359432x.2017.1384378 · Cited by 21
“Coping covers different forms of cognitive and acting behaviours, which can be modified (e.g., Clark & Beck, 2009; Lazarus, 1993; Nieuwenhuijsen et al., 2014; Taylor et al., 2016).”
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“A conceptual model of the change processes, active intervention elements, and potential moderators [16] of the BOOST intervention is presented in Fig.”
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“Those incorporating a psychological component show more consistent beneficial effects over the follow-up period (Taylor et al., 2016).”
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
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“7 11 Cost–benefit and improved health outcomes attributed to self-management might have substantial advantages in the United States due to the health care system’s complexity and high costs of treatment for chronic conditions that exacerbate health disparities associated with limited access and…”
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“Education and behaviour modification are used to motivate people to actively participate in managing their health and lessening the condition’s negative effects on their physical functioning and well-being (Patel et al. 2019; Taylor et al. 2016).”
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“…patients’ own management and responsibility for their condition, and many self-management programs have been developed in response to the increasing burden of chronic diseases and proven effective (Boyers et al., 2013; Henshall, Greenfield, & Gale, 2017) and cost-effective (Taylor et al., 2016).”
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“Among others, further studies would also look at interventions improving self-management of CP, given the probability of self-management of CP being effective 21,22 and cost-effective, 23 and the feasibility of digital self-management of CP interventions.”
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“In contrast, there was evidence supporting a nonzero LATE for two secondary outcomes, depression and social integration (Taylor et al., 2016).”
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Metadata
- Authors
- Taylor, S. J., Carnes, D., Homer, K., Pincus, T., Kahan, B. C., Hounsome, N., Eldridge, S., Spencer, A., Diaz-Ordaz, K., Rahman, A., Mars, T. S., Foell, J., Griffiths, C. J., & Underwood, M. R.
- Affiliations
- Queen Mary University of London (GB)
- Royal Holloway University of London (GB)
- University of Exeter (GB)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- University College Hospital (GB)
- University of Warwick (GB)
- Corresponding author
- Taylor, Stephanie JC
- ORCID
- Venue
- Programme Grants for Applied Research
- Published
- 2016-09
- Volume
- 4
- Issue
- 14
- Pages
- 1-440
- ISSN
- 2050-4322 (ISSN-L)
- 2050-4330
- OpenAlex
- W2521165122
- Cited by
- 44
- References
- 352
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 5 · 2023: 7 · 2022: 1 · 2021: 6 · 2020: 4 · 2019: 6 · 2018: 6 · 2017: 3
- FWCI
- 4.05
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Programme Grants for Applied Research (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Figshare (submittedVersion)
- Open Research Exeter (University of Exeter) (submittedVersion)
- Funders
- National Institute for Health Research (RP-PG-0707-10189)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- chronic musculoskeletal pain, self-management support, group intervention, pain-related disability, cost-effectiveness, pain acceptance, coping, anxiety and depression, self-efficacy, Bangladeshi community, primary care, physiotherapy, health care utilization, behaviour change theory, EQ-5D
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