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Running head: chronic pain support 1

Chronic Pain Support Groups and Weight Loss

Dana G. Houston

PSY 627

Missouri State University

Presented to Dr. David Stockburger

chronic pain support 2

Abstract

Not a day goes by without a news story running on the opioid epidemic. This is a study to

determine if a support group with a weight management component would be feasible for

chronic pain patients in my area. Patients at a pain management clinic were questioned about

how interested they would be in attending an in-person support group or an online support group

with exercise and weight tracking. The results of this study implied an online support group with

weight management component would be successful. I plan on implementing an online support

group and tracking the opioid usage of both participants and non-participants to see if there is a

correlation in support groups, weight loss, and decreased opioid usage.


Chronic Pain Support Groups and Weight Loss

I work at a spine pain clinic. I have a front seat view on how many patients are addicted

to high amounts of opioids and how difficult the current mandatory medication cuts are for them.

The time is now to come up with interventions to help these patients manage their pain in a

healthier way. However, decreasing the number of opioids patients take without doing so at the

expense of pain relief is going to require reading between the lines for better solutions.

Obesity has been proven in multiple studies to be directly linked to musculoskeletal pain.

Studies show that even a small reduction in weight can reduce the pain people feel (Kotowski &

Davis, 2010). As the percentage of Americans who are overweight and obese continue to rise, the

significance of maintaining a healthy weight will also continue to grow. As it stands for most

people trying to lose weight, many patients know they need to yet find weight loss results hard to

achieve. Several studies recently have found that social support networks where participants

have exercise and weight loss goals and get feedback from other participants within their group

lost more weight than using traditional methods of independent diet and exercise (Jane et al.,

2017).

I believe that creating a supportive environment conductive to health behavior changes is

the only way to help my patients lose weight. I plan on creating a MyFitnessPal group where the

patients at my clinic can join, anonymously, and partake in weekly exercise goals, post weight

loss success stories, keep track of daily calorie intake, and many other things the app has to offer.

By being responsible for posting a weekly weigh-in, I feel the patients will be more involved and

have more success with their weight loss goals. Also, I have already had patients come to me

asking about support groups for chronic pain in our area. To my surprise, there currently are not

any. Many of these same patients have developed depression through years of dealing with


chronic pain. I have frequent discussions with patients who have lost hope they will ever be able

to do the things they used to love.

This is when I realized we have two major problems in the way we treat chronic pain

patients. First, we are dealing with a population in which the majority are in pain and

overweight. Second, many of these patients suffer from some form of depression and are without

the support they need to get out of this rut. I believe that creating a support group where chronic

pain patients can talk to others who have been in their shoes would let them see that they are not

alone. If a support group could be created in our area and our patients had the option of joining in

on an online weight loss support group, this just might be enough to help these chronic pain

patients come through the opioid epidemic better than they started. However, in order to

maximize the chances of success for these two things, I must first get feedback from the patients.

I want to tailor the support group to where/when would work best for the majority. I want to get

as many people interested in the online group so that there are enough participants in it to be

effective when launched. Both of these must be done the best way possible the first time or I risk

losing the people who need it most from the very beginning.

Methods

A voluntary response sample was taken with participants consisting of patients attending

scheduled appointments at a spine pain clinic. These patients have all been screened prior to

acceptance as a patient and all have documented imaging (x-ray, CT, MRI) showing spine

problems. These patients are all given mandatory drug screens during their new-patient visit as

well as randomly during the year. Patients are required to bring all medications to each

appointment for pill counts and are screened on the online prescription drug monitoring program

(PMP) during each visit. We are able to see if any patient has gotten pain medication, sleeping


aids, or any type of sedative from any other provider, even across most states. There are very

strict rules in place to remain as a patient at the clinic and the patient will be released from care

immediately if any are broken. Every step is taken to ensure these patients are honest in their

report of pain and compliant with recommended treatment.

Questionnaire forms to determine if patients would be interested in attending a local

support group or joining an online weight loss support group were left at the front desk. Patients

were not in any way guided towards picking up the form, but the receptionist was instructed to

encourage the patients to check in and fill out any information the clinic needed prior to filling

out the questionnaire. There were instructions by the form to return in a designated location next

to the empty forms. Pens were available and it was clearly stated at the top of the form that all

responses remained anonymous. The patients submitted the questionnaires in a location where no

employee could easily access and every effort was made to ensure the participants felt it was

truly anonymous. Fifty forms were printed and left at the front to be collected once all 50 had

been filled out. Forty-seven forms were returned and therefore N=47 for this study.

Hypothesis

I will hypothesize that more people will respond that their pain is controlled “not well” or

“undecided” than “fair” or “well” due to the clinical depression many of these chronic pain

patients have acquired. However, I predict that 10% or less of patients will respond that they are

interested in attending a support group and that more people will respond that they would

consider the online group than the group meeting due to the inconvenience of having to drive to

a meeting at a specific time. I predict that no patients responding that they drive longer than 30

minutes to the clinic will be willing to meet in Little Rock for a support group because of the

time commitment involved.


Results

This project was to analyze chronic pain patients’ opinions of support groups and weight

loss. Patients were questioned on several factors surrounding their answers to try and understand

why an in-person or virtual support group would be more likely to succeed. Details about

positive responses were elicited to help plan for the implementation stage. Background

information of results: N = 47

Average years in chronic pain = 13.47


Average commute to clinic = 72.66 minutes


More than 86% of participants responded that their pain was “fair” or “well” controlled

over the past year. This was surprising, as I had originally predicted that more patients would

classify their pain managed as “not well” or “undecided.”

Over 27% of participants responded they would be interested in attending a support

group. This was much higher than I predicted. Additional information was gathered about where

and when would work best for those who responded they were interested to find out where and

when worked best for them.

Of the 6 responses stating the participant would be interested in joining a support group

and meeting in Little Rock, the maximum drive time to the clinic in Little Rock was 180

minutes.


A weekday morning was clearly the time of day of which participants who were

interested in meeting for a support group would most likely attend:


Consider Attending Yes No SigYears 7.62 15.64 0.051Drive in Mins 85.38 68.33 0.361

As I predicted, people who have been in chronic pain for a lower number of years would

be more willing to attend a support group. This finding was statistically significant. To my

surprise, the average drive time to Little Rock had the opposite effect on considering attending as

I predicted. People who were more willing to attend an in-person support group were actually

willing to drive farther.


Have you ever participated in a support group for patients with chronic pain? Yes – 11% No – 89%

Would you consider attending a support group to talk with other patients from our clinic about ways they

cope with pain, things that help, etc.? Yes – 28% No – 70%

If yes, would you attend in Little Rock? Yes- 18% No – 82%

If yes, when would be the best time for you?

Weekend morning–18% Weekend evening–18% Weekday morning–58% Weekday evening–6%

How would you consider your current weight?

Could gain a few pounds – 2% Haven’t thought about it – 17% Could lose a few pounds – 80%

Has a doctor / nurse practitioner ever encouraged you to lose weight? Yes – 41% No – 59%

Do you have a cell phone with apps on it? Yes – 81% No – 19%

Would you consider anonymously joining a Mocek Spine group on MyFitnessPal app? Optional features would include:

Tracking your exerciseTracking your weightCompeting in weekly walking challenges

Giving & receiving encouragement from other patients and Mocek Spine staff

Yes- 51% No – 49%

Almost double as many participants responded they would be interested in an online

support group via the app MyFitnessPal compared to meeting at a traditional support group.


Discussion

The objective of this project was to decide if an online or traditional support group would

generate enough interest to establish a successful program and if so how to set it up to facilitate

maximum participation. The first interesting finding was that more people considered their pain

fairly well managed than not. This was surprising as numerous studies show depression

correlates with chronic pain and I assumed these people would not be happy with their treatment.

I was also surprised to find over ¼ of the patients would consider attending a support group. This

was encouraging.

I had assumed that no patients responding that they drive longer than 30 minutes to the

clinic will be willing to meet in Little Rock for a support group because of the time commitment

involved. I was surprised to find a response of a patient willing to meet in Little Rock who

would have to drive three hours. The drive time was not correlated with willingness to drive to a

meeting. This lets me know that the people who are willing to meet are either very eager to do so

and probably young enough to do so.

Overall, the percentage of patients who would consider meeting in a traditional support

group was higher than I anticipated. However, even at over 27%, only half of them chose the

same timeframe as when would be best for them to meet. With an average commute to Little

Rock being over an hour and with best meeting times being spread out, I fear the actual

percentage of patients who would attend would be considerably lower.

However, with 48.9% of participants willing to consider joining the online group and

with the minimal variables for implementation, I believe this could be a very successful program.

Of those who reported interested in the online group, the number of years they have been in

chronic pain is distributed evenly enough that all participants should have someone who can


relate to them. Because of the results of this project, I plan to implement an online support group

for chronic pain patients where users can anonymously join using the MyFitnessPal app. Moving

forward with this project, I will track a participant group and a group not participating to

determine if forming an online support group with weight management component would

increase pain control and decrease the usage of opioids


References

Baker, D. W. (2017). History of the joint commission's pain standards: Lessons for today's

prescription opioid epidemic. Jama, 317(11), 1117-1118. doi:10.1001/jama.2017.0935

Jane, M., Hagger, M., Foster, J., Ho, S., Kane, R., & Pal, S. (2017). Effects of a weight

management program delivered by social media on weight and metabolic syndrome risk

factors in overweight and obese adults: A randomized controlled trial. Plos One, 12(6),

e0178326. doi:10.1371/journal.pone.0178326

Kotowski, S., & Davis, K. (2010). Influence of weight loss on musculoskeletal pain: Potential

short-term relevance. Work, 36(3), 295-304. doi:10.3233/WOR-2010-1031


Appendix A

* ALL FORMS WILL REMAIN ANONYMOUS *

1. Approximately how many years have you had chronic pain? _______

2. Approximately how long is your commute to Little Rock? _________________

3. Do you drive yourself or does someone else drive you? (circle one)

Drive myself Someone else drives me Either

4. How well would you consider your pain managed during the past year?

Not well Undecided Fair Well

5. How well do you feel others (family, friends) understand the pain you go through?

Not well Undecided Fair Well

6. Have you ever participated in a support group for patients with chronic pain? Yes No

7. Would you consider attending a support group to talk with other patients from our clinic about

ways they cope with pain, things that help, etc.? Yes No

a. If yes, would you attend in Little Rock? Yes No O ther?: ____________________

b. If yes, when would be the best time for you?

Weekend morning Weekend evening Weekday morning Weekday evening

8. How would you consider your current weight?

Could gain a few pounds Haven’t thought about it Could lose a few pounds

9. Has a doctor / nurse practitioner ever encouraged you to lose weight? Yes No

10. Do you have a cell phone with apps on it? Yes No

11. Would you consider anonymously joining a Mocek Spine group on MyFitnessPal app? a. Optional features would include:

Tracking your exerciseTracking your weightCompeting in weekly walking challengesGiving & receiving encouragement from other patients and Mocek Spine staff

Yes No

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