As you subscribe to my website, you are aware that many people report difficulty accessing pain care. Major care barriers exist for psychological or behavioral medicine treatment for acute and chronic pain. One of the biggest developments in behavioral pain care has been creating new treatment formats and delivery systems that transcend care barriers so people can have easy access.

To answer the call for effective and accessible pain treatments, in 2013 I developed Empowered ReliefTM at Stanford University. Empowered ReliefTM is a single-session, 2-hour pain management intervention that rapidly equips participants with evidence-based pain relief skills.

THE SCIENCE

With funding from the National Institutes of Health (NIH), we conducted a randomized trial of Empowered ReliefTM in 263 community-based individuals with moderate too severe chronic low back pain. Study participants were enrolled to one of three treatment groups:  (1) 2-hour Empowered ReliefTM, (2) a 2-hour no-skills health education control intervention, or (3) 8-sessions (16 hours) of the gold-standard psychological treatment for chronic pain: cognitive behavioral therapy (CBT). We hypothesized that three months after treatment, a highly condensed, single-session, skills-based pain intervention would yield comparable benefits as 8 sessions of traditional CBT for chronic pain.

JAMA Network Open published our study results in August 2021. Key takeaways:

  • For participants assigned to 8-session CBT, all symptoms were substantially improved from pre-treatment to post-treatment 3 months.
  • Empowered ReliefTM was comparable to CBT for reducing pain catastrophizing, pain intensity, and pain interference at 3 months post-treatment. Empowered ReliefTM also yielded clinically important reductions across a range of secondary outcomes, including pain bothersomeness, sleep disturbance, depression, anxiety, fatigue, physical function.
  • This was the first randomized trial showing multidimensional and lasting benefits after receiving a 2-hour class.

Because Empowered ReliefTM is a class and not group therapy, large class sizes are possible (e.g., up to 100 participants at a time).

Our study has received fantastic media coverage, including a press release from the NIH, coverage from MedPage Today, and inclusion in a story on psychological treatment for chronic pain that published in the New York Times (Nov 9, 2021).

But what about online delivery?

Dr. Maisa Ziadni recently led a randomized trial of online-received Empowered ReliefTM. Study participants were assigned to either receive Empowered ReliefTM or to a usual care wait list in 110 patients with different types of pain conditions. This study was conducted during COVID and participant engagement was excellent with 100 participants enrolled in the first 10 days the study was open.

Study results published in JMIR in September 2021. Key takeaways:

  • Findings showed that 3 months after receiving the single-session class, participants reported multidimensional reductions in symptoms.
  • These are the first data showing that treatment received online appears to have efficacy.
  • A Zoom-delivered single-session pain class may greatly scale access to effective pain care by making home-based treatment possible.
  • A brief, online pain intervention may provide more equitable access to care.

Since 2019 Stanford University has been certifying clinicians to deliver Empowered ReliefTM (note that need-based scholarships exist). To date, more than 300 clinicians have been certified. Empowered ReliefTM is delivered in 12 countries and in 6 languages. The intervention is embedded into pain care pathways at the Cleveland Clinic, some VA healthcare systems, Intermountain Healthcare, Humana, Scan Health, Harvard Healthcare, Stanford University, and Kaiser Permanente to name a few.

Stay tuned for exciting updates in 2022! First, we hope to conduct a national effectiveness study that will provide the critical data to inform which treatment works best for which patients (single-session Empowered Relief vs. 8-session CBT). Second, we will be scaling the frequency of our instructor certification workshops and including formats that accommodate international timezones.

Finally, just a note to acknowledge the vast amount of teamwork at Stanford University and beyond that has contributed the Empowered Relief science and dissemination. This has truly been a labor of love and it has taken a village to bring it to the public at scale.

Until next time,

Beth

Photo by laflor on iStock