Education in health for individuals with chronic pain: clinical trial

Vieira, Ana Shirley Maranhão; Vidal, Diogo Guedes; Sousa, Hélder Fernando Pedrosa e; Dinis, Maria Alzira Pimenta; Sá, Katia Nunes

doi:10.5935/2595-0118.20220013

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ORIGINAL ARTICLE • BrJP 5 (1) • Jan-Mar 2022 • https://doi.org/10.5935/2595-0118.20220013 copy

Education in health for individuals with chronic pain: clinical trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

The use of socio-educational booklets is recommended for assisting in the control of chronic pain. However, the efficacy and safety of these light technologies have not yet been tested enough for widespread application, based on the model of scientific evidence. This study aimed to assess the effect of a health education program in individuals suffering from CP using the EducaDor booklet.

METHODS:

Randomized clinical trial conducted with chronic pain patients from Unidades Básicas de Saúde (UBS – Primary Health Care Units) in Salvador, Bahia, Brazil. Assessments were performed using the Brief Pain Inventory (BPI), Visual Analog Scale of Pain (VAS-P) and World Health Organization Quality of Life instrument-Bref (WHOQoL-bref ), before and after the intervention, for intra and intergroup analyses: Test Group (Booklet) and Control Group (Conventional Care). The contents of the EducaDor booklet were presented didactically in six meetings with an interval of one week between them.

RESULTS:

The sample was composed of 10 individuals in each group (n = 20). In the Control Group, there was an increase in pain intensity (p=0.034), while the Test Group showed a reduction in pain intensity (p=0.015) and a lower level of interference in the physical, psychological, social relationships and environmental quality of life domains (p<0.05). In the intergroup comparisons, an improvement was observed in the domain of social relationships in the Test Group (p=0.015).

CONCLUSION:

EducaDor booklet has been shown to be effective and safe for the education of patients suffering from CP by reducing pain intensity and improving patients’ quality of life.

Keywords:
Chronic pain; Clinical trial; Health education; Quality of life

Domains	Methodological strategy
What is pain?	To me, what is pain? All participants individually received paper and a pencil to make a drawing that represented how they perceived the pain or what pain was to them. After this, all participants individually, i.e., one by one, showed their poster, and proceeded with their presentation: name and their pain perception explanation. What is pain? Based on the presentations, the researcher presented the first domain of the booklet, bringing tags with the main phrases from the booklet.
Acute pain: useful pain.	The path of pain The researcher presented the “path of pain” by means of drawings, mediating the discussion and understanding of the concepts.
Chronic pain: persistent pain.	Differences between acute and chronic pain The researcher divided the group into two parts. One group conceptualized acute pain and the other, chronic pain. To do this, one group received the tag with the designation ACUTE PAIN and the other group, with the designation CHRONIC PAIN. In addition, tags were made available containing the characteristics of acute and chronic pain. One group created a panel with the characteristics of acute pain, and the other, a panel with the characteristics of chronic pain.
Living with pain	Numbers of pain – you are not alone The researcher presented the results of researchers showing the number of persons who live with chronic pain. How did the participants live with chronic pain? One by one, the participants reported the consequences brought by chronic pain to the lives of participants.

Variables	Control Group	Test Group	p-value
Variables	n (%)	n (%)	p-value
Gender
Male	0 (0.0)	2 (20.0)	0.136
Female	10 (100.0)	8 (80.0)
Marital Status
Single	3 (30.0)	4 (40.0)	0.565
Married	6 (60.0)	6 (60.0)
Divorced	1 (10.0)	0 (0.0)
Race/Skin Color
Yellow	0 (0.0)	2 (20.0)	0.264
Mulatto/or/Dark	6 (60.0)	6 (60.0)
Black	4 (40.0)	2 (20.0)
Smoker
Yes	1 (10.0)	0 (0.0)
No	5 (50.0)	9 (90.0)	0.139
Alcohol consumption
No	8 (80.0)	7 (70.0)	0.659
Drink at weekends	2 (20.0)	2 (20.0)
Once a month	0 (0.0)	1 (10.0)
I Can Read
Yes	10 (100.0)	10 (100.0)	Na
No	0 (0.0)	0 (0.0)
I know how to write
Yes	10 (100.0)	10 (100.0)	Na
No	0 (0.0)	0 (0.0)
Years of Education*
5 - 9	4 (50.0)	3 (37.5)	0.206
10 - 15	3 (37.5)	5 (62.5)
>15	1 (12.5)	0 (0.0)
Currently working
Yes	6 (60.0)	6 (60.0)	0.525
No	2 (20.0)	3 (30.0)
Student	1 (10.0)	0 (0.0)
Retired	0 (0.0)	1 (10.0)
Unemployed	1 (10.0)	0 (0.0)
Family Members**
1 to 2 persons	3 (37.5)	3 (42.9)	0.710
3 to 5 persons	5 (62.5)	4 (57.1)
Responsibility for home
Only one resident	3 (30.0)	5 (50.0)	0.361
More than one resident	7 (70.0)	5 (50.0)
Head of the family
The respondent	2 (20.0)	5 (50.0)	0.349
Spouse/Partner	7 (70.0)	4 (40.0)
Mother	1 (10.0)	1 (10.0)

	Mean (SD)	Min - Max	Mean (SD)	Min - Max	p-value
Age	48.1 (7.5)	32 - 59	48.3 (7.7)	37 - 58	0.954
Weight	76.2 (12.2)	60 - 98	77.1 (18.3)	50 - 114	0.903
Height	1.60 (0.1)	1.51 - 1.69	1.62 (0.1)	1.50 - 1.86	0.661
BMI	29.8 (4.9)	24.0 - 38.4	29.1 (3.7)	21.6 - 34.3	0.722

Variables	Control Group	Test Group	p-value
Variables	n (%)	n (%)	p-value
Diseases diagnosed
Diabetes mellitus	1 (10.0)	0 (0.0)
Renal disease/heart disease	0 (0.0)	1 (10.0)	0.504
Systolic arterial hypertension	3 (30.0)	1 (10.0)
Systolic arterial
hypertension/ diabetes mellitus	1 (10.0)	1 (10.0)
Uses drugs for disease*
Yes	5 (100)	3 (75.0)	0.236
No	0 (0.0)	1 (25.0)
Time of pain experience (years)
< 5	3 (30.0)	4 (40.0)	0.645
5 to 10	6 (60.0)	4 (40.0)
>10	1 (10.0)	2 (20.0)
Is pain related to disease**
Yes	1 (16.7)	2 (40.0)	0.387
No	5 (83.3)	3 (60.0)
Time of day when pain is occurs more frequently
Morning	1 (10.0)	1 (10.0)	0.162
Night	5 (50.0)	9 (90.0)
Day	2 (20.0)	0 (0.0)
At no specific time	2 (20.0)	0 (0.0)
Assessment of health status
Excellent	1 (10.0)	0 (0.0)	0.396
Very good	0 (0.0)	1 (10.0)
Good	7 (70.0)	6 (60.0)
Poor	1 (10.0)	3 (30.0)
Very poor	1 (10.0)	0 (0.0)

BPI	Control		p-value
	Before	After
	Median (P25-P75)	Median (P25-P75)
Categorized Intensity (zero to 10)	1.00 (0.00-2.00)	1.00 (1.00-2.00)	0.034
Value that shows how much pain you are feeling now	4.00 (0.00-7.00)	8.00 (5.00-9.00)	0.011
Interference of pain in general activity	5.50 (1.50-8.50)	5.00 (0.00-8.25)	0.646
Interference of pain in mood	5.50 (2.25-10.0)	5.50 (0.00-8.00)	0.540
Interference of pain in ability to walk	3.50 (0.00-7.25)	5.00 (0.00-8.25)	0.722
Interference of pain in work	5.00 (0.75-7.25)	5.00 (2.25-7.25)	0.758
Interference of pain in relationships with others	2.50 (0.00-7.50)	2.50 (0.00-5.50)	0.574
Interference of pain in sleep	7.00 (3.00-9.25)	6.00 (1.50-10.0)	0.758
Interference of pain in ability to appreciate life	4.00 (0.00-6.25)	1.50 (0.00-5.50)	0.672

BPI	Test
Categorized Intensity (zero to 10)	1.00 (0.00-2.00)	0.00 (0.00-1.25)	0.102
Value that shows how much pain you are feeling now	5.00 (0.00-10.00)	2.00 (0.00-5.50)	0.120
Interference of pain in general activity	3.50 (0.00-9.25)	2.50 (0.00-5.25)	0.341
Interference of pain in mood	6.50 (0.00-9.75)	0.00 (0.00-3.25)	0.108
Interference of pain in ability to walk	4.00 (0.00-8.50)	0.50 (0.00-5.25)	0.041
Interference of pain in work	7.00 (0.00-10.00)	0.00 (0.00-9.00)	0.223
Interference of pain in relationships with others	4.00 (0.00-7.50)	0.00 (0.00-1.50)	0.149
Interference of pain in sleep	7.00 (0.00-9.25)	5.50 (0.00-10.00)	0.527
Interference of pain in ability to appreciate life	1.00 (0.00-8.50)	0.00 (0.00-5.50)	0.180
VAS-P (0 to 2)	Control
	1.00 (0.00-2.00)	2.00 (1.00-2.00)	0.034
	Test
	1.00 (0.00-2.00)	0.00 (0.00-1.25)	0.157

BPI	Before		After
BPI	Control Median (P25-P75)	Test Median (P25-P75)	Control Median (P25-P75)	Test Median (P25-P75)
Categorized Intensity (zero-10)	1.00 (0.00-2.00)	1.00 (0.00-2.00)	1.00 (1.00-2.00)	0.00 (0.00-1.25)
	1.000		0.009
Value that shows how much pain you are feeling now	4.00 (0.00-7.00)	5.00 (0.00-10.00)	8.00 (5.00-9.00)	2.00 (0.00-5.50)
	0.481		0.007
Interference of pain in general activity	5.50 (1.50-8.50)	3.50 (0.00-9.25)	5.00 (0.00-8.25)	2.50 (0.00-5.25)
	0.579		0.481
Interference of pain in mood	5.50 (2.25-10.0)	6.50 (0.00-9.75)	5.50 (0.00-8.00)	0.00 (0.00-3.25)
	0.796		0.218
Interference of pain in ability to walk	3.50 (0.00-7.25)	4.00 (0.00-8.50)	5.00 (0.00-8.25)	0.50 (0.00-5.25)
	0.912		0.190
Interference of pain in work	5.00 (0.75-7.25)	7.00 (0.00-10.00)	5.00 (2.25-7.25)	0.00 (0.00-9.00)
	0.529		0.579
Interference of pain in relationships with others	2.50 (0.00-7.50)	4.00 (0.00-7.50)	2.50 (0.00-5.50)	0.00 (0.00-1.50)
	0.842		0.143
Interference of pain in sleep	7.00 (3.00-9.25)	7.00 (0.00-9.25)	6.00 (1.50-10.0)	5.50 (0.00-10.00)
	0.853		0.684
Interference of pain in ability to appreciate life	4.00 (0.00-6.25)	1.00 (0.00-8.50)	1.50 (0.00-5.50)	0.00 (0.00-5.50)
	1.000		0.912
VAS-P (0 to 2)	1.00 (0.00-2.00)	1.00 (0.00-2.00)	2.00 (1.00-2.00)	0.00 (0.00-1.25)
	1.000		0.015

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[1] Correspondence to: Ana Shirley Maranhão Vieira E-mail: asmvieira@bahiana.edu.br