Highlights
- •First study to test a cognitive behavioral intervention for painful chemotherapy-induced peripheral neuropathy (CIPN).
- •Worst CIPN pain was assessed at baseline and 8 weeks later via 7-day diary.
- •Cognitive-behavioral intervention was superior to usual care on worst CIPN pain.
- •Low Web site usage and high attrition was observed in the intervention arm.
- •Further research is needed to identify mediators of CIPN pain improvement.
Abstract
The purpose of this pilot, parallel, randomized controlled trial was to examine the
efficacy of a self-guided online cognitive and behaviorally-based pain management
intervention (Proactive Self-Management Program for Effects of Cancer Treatment [PROSPECT])
to reduce “worst” pain for individuals with chronic painful chemotherapy-induced peripheral
neuropathy (CIPN). Secondary outcomes included “average” pain, nonpainful CIPN symptom
severity, impression of change, and pain interference. Sixty patients with chronic
painful CIPN were recruited from 5 outpatient academic and community cancer centers.
Patients were randomized in a 1:1 ratio to receive either 8 weeks of PROSPECT or usual
care. A 7-day electronic “worst” pain intensity diary and standardized measures of
pain interference, nonpainful CIPN symptom severity, impression of change, and “average”
pain were administered pre/post intervention. Postintervention mean scores were evaluated
between groups using analysis of covariance adjusting for baseline. Individuals who
received the PROSPECT intervention (n = 19) had significantly greater improvements
in “worst pain” compared with individuals receiving usual care (n = 19; P = .046, d = .58). There were no significant differences in mean scores between groups for the
secondary outcomes (n = 42). A larger, adequately powered study testing the PROSPECT
intervention is needed to determine if improvements in pain may be sustained, evaluate
the effect of the intervention on the secondary outcomes, and identify mediators of
pain intensity-related improvement.
Perspective
This study explores the efficacy of an 8-week online cognitive behavioral pain management
intervention for chronic painful CIPN. Intervention use resulted in greater improvements
in “worst” pain than usual care alone. The findings provide preliminary support for
the efficacy of a nonpharmacological intervention for chronic painful CIPN.
Key words
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Article info
Publication history
Published online: December 08, 2017
Accepted:
November 27,
2017
Received in revised form:
September 7,
2017
Received:
August 8,
2017
Footnotes
This work was supported by the University of Michigan School of Nursing New Investigator Award and Rackham Graduate Student Research Grant. The funding source had no role in study design, data collection/analysis, or manuscript preparation.
Creation of the Proactive Self-Management Program for Effects of Cancer Treatment Web site was supported by the Damon Runyon Cancer Research Foundation (CI-53-10) to Norah Lynn Henry, MD, PhD. Proactive Self-Management Program for Effects of Cancer Treatment was adapted from the Web site, Fibroguide.com, which was developed with support from Grant numbers R01-AR050044 (National Institute of Arthritis and Musculoskeletal and Skin Diseases/National Institutes of Health), and DAMD 17-00-2-0018 (Department of Defense).
Dr. Williams has served as a consultant to Community Health Focus, Inc, served as a grant reviewer for Pfizer independent grants for Learning and Change, and is currently the President of the American Pain Society. The other authors have no conflicts of interest to declare.
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© 2017 by the American Pain Society
