An Innovative Electronic Health Toolkit (Our Whole Lives for Chronic Pain) to Reduce Chronic Pain in Patients With Health Disparities: Open Clinical Trial

Gardiner, Paula; D’Amico, Salvatore; Luo, Mandy; Haas, Niina

doi:10.2196/14768

Cited by 16 publications

(12 citation statements)

References 68 publications

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“…The study team (licensed dietician or nutritionist [BO], a culinary-trained family medicine physician [LJM], and a mindfulness-trained family physician [PG]) adapted the content from OWL (version 2) to create OWL-H. Most of the original content of OWL (version 2) created for patients with chronic pain was used ( Table 1 outlines the new content that was added to strategies to reduce HTN) [ 24 ]. The third version added evidence-based self-management strategies for reducing HTN and cardiac risk factors such as cooking videos and recipes using the Dietary Approaches to Stop Hypertension (DASH) [ 32 , 33 ] and Mediterranean diets.…”

Section: Methodsmentioning

confidence: 99%

“…The OWL curriculum introduces patients to the principles of mindfulness practices, nutrition, stress reduction, and movement [ 22 , 23 ]. In 2017, OWL (version 2) was tested to determine its effectiveness as a stand-alone intervention for patients with chronic pain; participants showed significant reduction in depression, pain interference, and average pain impact, accompanied by 13% reduction in opioid use ( P =.03) [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Our Whole Lives for Hypertension and Cardiac Risk Factors—Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial

Gardiner¹,

McGonigal²,

Villa³

et al. 2022

JMIR Form Res

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Background Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. Objective The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. Methods We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. Results Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants’ average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income <US $30,000 per year. Among the 22 participants who logged in to OWL-H, the average number of mindfulness practices completed was 7 and the average number of module sessions accessed was 4. In all, 73% (16/22) of participants reported that they were “very satisfied” with using OWL-H to help manage their HTN. Participants’ blood pressure knowledge significantly increased from baseline (mean 5.58, SD 1.44) to follow-up (mean 6.13, SD 1.23; P=.03). Participants significantly increased their adherence to a Mediterranean diet from baseline (mean 7.65, SD 2.19) to follow-up (mean 9, SD 1.68; P=.004). Participants’ self-efficacy in applying heart-healthy habits, as measured by the Hypertension Self-Care Profile Self-Efficacy Instrument, increased from baseline (mean 63.67, SD 9.06) to follow-up (mean 65.54, SD 7.56; P=.14). At the 8-week follow-up, 82% (18/22) of the participants had self-reported their blood pressure on the OWL-H platform at least once during the 8 weeks. Conclusions The eHealth platform for HTN self-management, OWL-H, and accompanying in-person TKMGVs have the potential to effectively improve lifestyle management of HTN. Trial Registration ClinicalTrials.gov NCT03974334; https://clinicaltrials.gov/ct2/show/NCT03974334

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Our Whole Lives for Hypertension and Cardiac Risk Factors—Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial

Gardiner¹,

McGonigal²,

Villa³

et al. 2022

JMIR Form Res

Self Cite

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“…The PROMIS-29 has been widely used including in populations with obesity and chronic pain. (37)(38)(39)(40)(41)(42)(43) Participants answered four questions addressing pain interference (Cronbach's Alpha = .94): "In the past 7 days, how much did pain interfere with your day to day activities", "work around the house", "your ability to participate in social activities", "with your household chores". Responses were on a scale from one to ve, and de ned as: not at all (1), a little bit (2), somewhat (3), quite a bit (4), very much (5).…”

Section: Methodsmentioning

confidence: 99%

Racial and Weight Discrimination Associations with Pain Intensity and Pain Interference in An Ethnically Diverse Sample of Adults with Obesity: A Baseline Analysis of the Clustered Randomized-Controlled Clinical Trial the Goals for Eating and Moving (GEM) Study

Merriwether

Wittleder

Cho

et al. 2021

Preprint

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Background: Everyday experiences with racial (RD) and weight discrimination (WD) are risk factors for chronic pain in ethnically diverse adults with obesity. However, the individual or combined effects of RD or WD on pain in adults with obesity is not well understood. There are gender differences and sexual dimorphisms in nociception and pain, but the effect of gender on relationships between RD and WD in ethnically diverse adults with obesity has not been examined. The goals of this study were to: 1) examine whether weight and racial discrimination are associated with pain intensity and interference, and 2) explore gender as a moderator of the effects of WD and RD on pain.Methods: This is a baseline data analysis from a randomized controlled weight-management trial. Eligible participants were English or Spanish-speaking (ages 18-69 years) and had either a body mass index of ≥ 30 kg/m2 or ≥ 25 kg/m2 with weight-related comorbidity. WD and RD were measured using the Experiences of Discrimination questionnaire (EOD). Pain outcome (pain interference and intensity) were measured using the PROMIS 29 adult profile V2.1. Linear regression models were performed to determine the associations between WD, RD, and gender, with pain outcomes.Results. On average participants reported mild pain interference (T-score: 52.65±10.29) and moderate pain intensity (4.23±3.15, scale: 0-10). There was a significant interaction effect of RD and gender on pain interference. RD was more strongly associated with pain interference in women (b = .47, SE = .08, p < 001), compared to men (b = .14, SE = .07, p = .06). There were no significant interaction effects between RD and gender on pain intensity, or between WD and gender on pain interference or intensity. Conclusions: Pain is highly prevalent in adults with obesity, and is impacted by experiences of racial and weight discrimination. Further, discrimination against adults with obesity and chronic pain could exacerbate existing racial disparities in pain and weight management. Asking ethnically diverse adults with obesity about their pain and their experiences of racial and weight discrimination could help clinicians make culturally informed decisions that address barriers to pain relief and weight loss.Trial Registration: NCT03006328

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“…Digital mental health interventions can potentially address the issues of accessibility, rising health care costs, low availability of therapeutic care, and other barriers [ 35 , 36 ] associated with standard in-person treatments for chronic pain [ 37 ] and mental health [ 38 , 39 ]. Studies have reported that digitally delivered mental health interventions have a positive role to play in the self-management of depression and anxiety [ 40 , 41 ] and have been found effective in reducing the impact of chronic pain on the quality of life [ 42 ].…”

Section: Introductionmentioning

confidence: 99%

Delivery of a Mental Health Intervention for Chronic Pain Through an Artificial Intelligence–Enabled App (Wysa): Protocol for a Prospective Pilot Study

Gupta¹,

Malik²,

Sinha³

2022

JMIR Res Protoc

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Background Patients with chronic pain often experience coexisting, long-term and debilitating mental health comorbidities such as depression and anxiety. Artificial intelligence–supported cognitive behavioral therapy (AI-CBT) interventions could offer cost-effective, accessible, and potentially effective resources to address this problem. However, there is not enough research conducted about the efficacy of AI-CBT interventions for chronic pain. Objective This prospective cohort study aims to examine the efficacy and use of an AI-CBT intervention for chronic pain (Wysa for Chronic Pain app, Wysa Inc) using a conversational agent (with no human intervention). To the best of our knowledge, this is the first such study for chronic pain using a fully-automated, free-text–based conversational agent. Methods Participants with self-reported chronic pain (n=500) will be recruited online on a rolling basis from April 2022 through posts on US-based internet communities within this prospective cohort. Informed consent is received from participants within the app, and the Wysa for Chronic Pain intervention is delivered remotely for 8 weeks. Outcome measures including a numeric pain rating scale and Patient-Reported Outcomes Measurement Information System–Pain Interference, Generalized Anxiety Disorder–7, and Patient Health Questionnaire–9 questionnaires administered to test the effectiveness of the intervention on reducing levels of pain interference, depression, and anxiety. The therapeutic alliance created with the conversational agent will be assessed through the Working Alliance Inventory–Short Revised instrument. Retention and use statistics will be observed for adherence and engagement. Results The study will open for recruitment in April 2022, and data collection is expected to be completed by August 2022. The results for the primary outcomes are expected to be published by late 2022. Conclusions Mental health conversational agents driven by artificial intelligence could be effective in helping patients with chronic pain learn to self-manage their pain and common comorbidities like depression and anxiety. The Wysa for Chronic Pain app is one such digital intervention that can potentially serve as a solution to the problems of affordability and scalability associated with interventions that include a human therapist. This prospective study examines the efficacy of the app as a treatment solution for chronic pain. It aims to inform future practices and digital mental health interventions for individuals with chronic pain. International Registered Report Identifier (IRRID) PRR1-10.2196/36910

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An Innovative Electronic Health Toolkit (Our Whole Lives for Chronic Pain) to Reduce Chronic Pain in Patients With Health Disparities: Open Clinical Trial

Cited by 16 publications

References 68 publications

Our Whole Lives for Hypertension and Cardiac Risk Factors—Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial

Our Whole Lives for Hypertension and Cardiac Risk Factors—Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial

Racial and Weight Discrimination Associations with Pain Intensity and Pain Interference in An Ethnically Diverse Sample of Adults with Obesity: A Baseline Analysis of the Clustered Randomized-Controlled Clinical Trial the Goals for Eating and Moving (GEM) Study

Delivery of a Mental Health Intervention for Chronic Pain Through an Artificial Intelligence–Enabled App (Wysa): Protocol for a Prospective Pilot Study

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