Effect of a virtual pain coach on pain management discussions: a pilot study.

There is a need to enhance patient and practitioner pain communications. A pain communication plus virtual pain coach intervention was tested in the primary care setting for the effect on communication of osteoarthritis pain information by older adults aged ≥60 years, on practitioners' pain management changes, and on older adults' reduced pain and depressive symptoms 1 month later. A randomized controlled pilot study design was used. Twenty-three older adults with osteoarthritis pain were randomly assigned to the pain communication plus virtual pain coach group or the pain communication-only group. Pain communication consisted of a video of important osteoarthritis pain information. The coach consisted of practicing out loud with a virtual pain coach via laptop computer. Pain and depressive symptoms were measured with, respectively, the Brief Pain Inventory Short Form and the Beck Depression Inventory II before intervention and 1 month later. Immediately after the intervention, older adults had their primary care visits, which were audiotaped, transcribed, and content analyzed for older adults' communicated pain information and practitioners' pain management changes. Older adults in the pain communication plus virtual pain coach group described significantly more pain source information and were prescribed significantly more osteoarthritis pain treatments than older adults in the pain communication-only group. A nonsignificant trend in pain intensity and depressive symptoms reduction resulted for older adults in the pain communication plus virtual pain coach group 1 month later. The virtual pain coach presents a possible strategy for increasing pain management discussions between practitioners and older adults with persistent pain.

[1]  D. Merkle,et al.  Use of recommended osteoarthritis pain treatment by older adults. , 2009, Journal of advanced nursing.

[2]  S. Morley,et al.  A confirmatory factor analysis of the Beck Depression Inventory in chronic pain , 2002, PAIN.

[3]  J. D'eon,et al.  Psychometric properties of the Beck Depression Inventory-Second Edition (BDI-II) in individuals with chronic pain , 2008, PAIN®.

[4]  J. Farrar,et al.  The clinical importance of changes in the 0 to 10 numeric rating scale for worst, least, and average pain intensity: analyses of data from clinical trials of duloxetine in pain disorders. , 2010, The journal of pain : official journal of the American Pain Society.

[5]  E B Ryan,et al.  Patronizing the Old: How Do Younger and Older Adults Respond to Baby Talk in the Nursing Home? , 1994, International journal of aging & human development.

[6]  Takuji Nishimura,et al.  Mersenne twister: a 623-dimensionally equidistributed uniform pseudo-random number generator , 1998, TOMC.

[7]  David Cella,et al.  Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. , 2008, The journal of pain : official journal of the American Pain Society.

[8]  P Tugwell,et al.  OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. , 2008, Osteoarthritis and cartilage.

[9]  H. Giles,et al.  Accommodating the elderly: Invoking and extending a theory , 1988, Language in Society.

[10]  Yutaka Aoki,et al.  Physician gender effects in medical communication: a meta-analytic review. , 2002, JAMA.

[11]  H. Giles,et al.  Accommodating intergenerational contact: A critique and theoretical model , 1993 .

[12]  C. Lindley,et al.  Is patient satisfaction a legitimate outcome of pain management? , 2003, Journal of pain and symptom management.

[13]  D. Tripathy,et al.  Randomized clinical trial of the effectiveness of a self-care intervention to improve cancer pain management. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  Suzanne G. Leveille,et al.  Improving Patient-Clinician Communication About Chronic Conditions: Description of an Internet-Based Nurse E-Coach Intervention , 2008, Nursing research.

[15]  C. Kimberlin,et al.  Cancer patient and caregiver experiences: communication and pain management issues. , 2004, Journal of pain and symptom management.

[16]  D. Mcdonald,et al.  Assisting Older Adults to Communicate Their Postoperative Pain , 2005, Clinical nursing research.

[17]  C. Cleeland,et al.  People in pain: how do they seek relief? , 2007, The journal of pain : official journal of the American Pain Society.

[18]  A. Kalet,et al.  Medical students retain pain assessment and management skills long after an experiential curriculum: A controlled study , 2009, PAIN.

[19]  S. Perera,et al.  The State of Chronic Pain Education in Geriatric Medicine Fellowship Training Programs: Results of a National Survey , 2005, Journal of the American Geriatrics Society.

[20]  R. Kravitz,et al.  Individualized patient education and coaching to improve pain control among cancer outpatients. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  Elvy Ickowicz Pharmacological Management of Persistent Pain in Older Persons , 2009, Journal of the American Geriatrics Society.

[22]  Zoe Strickler,et al.  An interactive technology approach to educate older adults about drug interactions arising from over-the-counter self-medication practices. , 2002, Public health nursing.

[23]  M. Zalon,et al.  Comparison of Pain Measures in Surgical Patients , 1999, Journal of Nursing Measurement.

[24]  D. Lurie,et al.  Criterion validity, severity cut scores, and test-retest reliability of the Beck Depression Inventory-II in a university counseling center sample. , 2002 .

[25]  S. Czaja,et al.  Age differences in attitudes toward computers. , 1998, The journals of gerontology. Series B, Psychological sciences and social sciences.

[26]  S. Gabriel,et al.  Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. , 2008, Arthritis and rheumatism.

[27]  Klaus Krippendorff,et al.  Content Analysis: An Introduction to Its Methodology , 1980 .

[28]  T. Gifford,et al.  Effect of a virtual pain coach on older adults' pain communication: a pilot study. , 2011, Pain management nursing : official journal of the American Society of Pain Management Nurses.

[29]  J. Fedo,et al.  The effect of pain question phrasing on older adult pain information. , 2009, Journal of pain and symptom management.