Peer Support Intervention Improves Pain-Related Outcomes Among Rural Adults With Diabetes and Chronic Pain at 12-Month Follow-Up

Yulia Khodneva; Joshua Richman; Susan Andreae; Andrea Cherrington; Monika M Safford

doi:10.1111/jrh.12422

Peer Support Intervention Improves Pain-Related Outcomes Among Rural Adults With Diabetes and Chronic Pain at 12-Month Follow-Up

J Rural Health. 2021 Mar;37(2):394-405. doi: 10.1111/jrh.12422. Epub 2020 Mar 2.

Authors

Yulia Khodneva¹, Joshua Richman², Susan Andreae³, Andrea Cherrington¹, Monika M Safford⁴

Affiliations

¹ Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
² Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
³ Department of Kinesiology, University of Wisconsin - Madison School of Education, Madison, Wisconsin.
⁴ Department of Internal Medicine, Weill Cornell Medical College, New York, New York.

Abstract

Purpose: Adults with diabetes mellitus (DM) suffer often from chronic pain, yet evidence-based interventions for comorbid pain and DM are scarce. We tested the effect of a peer-led cognitive behavioral training (CBT) intervention on pain self-efficacy (PSE), pain intensity, and pain-related functional limitations (PRFL) in adults with DM, 1 year after trial initiation.

Methods: The yearlong "Living Healthy" cluster-randomized trial included 230 residents of rural Alabama with DM, who reported pain in the past month; communities were treated as clusters. Intervention participants received a peer-delivered 8-session structured CBT intervention in the context of diabetes self-management; attention control arm participants received a peer-delivered 8-session general health education program. Outcomes included PSE (Arthritis Self-Efficacy Scale, range 10-100); pain intensity (McGill Pain Questionnaire, range 0-45); and PRFL (Western Ontario and McMaster Universities Osteoarthritis Index scale, range 0-100). We examined control-intervention differences in changes in outcome scores from baseline to 3-month and 12-month follow-up, adjusted for clustering.

Findings: The 195 participants with follow-up data were aged 59 ± 10.4 years, 96% were African American, 79% were women, and 80% reported pain on the day of baseline data collection. At 3-month follow-up, PSE increased more for intervention (21-point increase) than control (5-point increase) participants (P for control-intervention (C-I) difference in change < .001); pain intensity decreased for both groups; and PRFL decreased only for intervention participants (-11 score; P for C-I difference in change < .001). Results were sustained at 12 months, and pain intensity significantly improved in only the intervention arm (P for C-I difference in change = .01).

Conclusions: This peer-delivered CBT intervention improved pain self-efficacy, pain-related functional limitations, and pain intensity over 12 months among rural participants with DM and chronic pain.

Keywords: cognitive-behavioral therapy; diabetes; pain; peer support; rural.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
Chronic Pain* / therapy
Counseling
Diabetes Mellitus*
Female
Follow-Up Studies
Humans
Rural Population

Abstract

Publication types

MeSH terms

Grants and funding