@Article{info:doi/10.2196/68292,
author="Edwards, Karlyn A
and Dildine, Troy C
and You, Dokyoung S
and Herrick, Ashley M
and Darnall, Beth D
and Mackey, Sean C
and Ziadni, Maisa S",
title="Zoom-Delivered Empowered Relief for Chronic Pain: Observational Longitudinal Pilot Study Exploring Feasibility and Pain-Related Outcomes in Patients on Long-Term Opioids",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="11",
volume="9",
pages="e68292",
keywords="Empowered Relief; single session; chronic pain; prescription opioids; telehealth; daily data; pain intensity; pain catastrophizing",
abstract="Background: Patients with chronic pain on long-term opioid therapy often face barriers to accessing effective nonpharmacological treatments, including the burden of multiple sessions, lack of trained clinicians, and travel time. Empowered Relief (ER), a 2-hour, single-session pain relief skills class, can improve pain and quality of life among patients with chronic pain when delivered in person or virtually. Objective: This study examined the impact of Zoom-delivered ER among people with chronic pain on long-term opioid therapy. We assessed (1) the feasibility and acceptability of Zoom-delivered ER; (2) changes in pain and opioid use outcomes at 3 and 6 months after treatment; and (3) daily associations among pain, opioid dose, and the Pain Catastrophizing Scale (PCS) before and after treatment. Methods: During the early COVID-19 pandemic, we conducted an uncontrolled pilot study of a Zoom-delivered ER among 60 adults (n=45, 76{\%} female participants; n=52, 88{\%} White participants) experiencing chronic pain who were receiving daily prescribed opioids (≥10 morphine-equivalent daily dose). Participants completed assessments at enrollment, before class, after class, 3 months after treatment, and 6 months after treatment. Furthermore, participants completed 2 daily assessment periods (spanning 14 consecutive days) before and after the class. We used a multilevel modeling approach to examine (1) the raw changes in PCS, average pain intensity, pain interference, and self-reported opioid dose at 3 and 6 months after treatment and (2) daily-level changes in average pain intensity and opioid dose before and after the class. Results: Of the 60 participants enrolled, 41 (68{\%}) attended the class and 24 (59{\%} of the 41 class attendees) reported satisfaction with the Zoom-delivered class. PCS score was significantly reduced at 3 months ($\beta$=--3.49, P=.01; Cohen d=0.35) and 6 months after treatment ($\beta$=--3.61, P=.01; Cohen d=0.37), and pain intensity was significantly reduced at 3 months ($\beta$=--0.56, P=.01; Cohen d=0.39) compared to enrollment. There were no significant reductions in pain interference or opioid dose. Across daily assessments, higher daily pain catastrophizing was associated with worse daily pain ($\beta$=.42, P<.001) and higher self-reported opioid use ($\beta$=3.14, P<.001); daily pain intensity significantly reduced after the class ($\beta$=--.50, P<.001). People taking prescribed opioids as needed trended toward decreasing their daily opioid use after the class ($\beta$=--9.31, P=.02), although this result did not survive correction for multiplicity. Conclusions: Improvements to future Zoom-delivered ER iterations are needed to improve feasibility and acceptability among people with chronic pain and daily prescribed opioid use. Despite this, findings show a promising preliminary impact of the intervention on pain outcomes. A larger randomized controlled trial of Zoom-delivered ER among this patient population is currently under way. ",
issn="2561-326X",
doi="10.2196/68292",
url="https://formative.jmir.org/2025/1/e68292",
url="https://doi.org/10.2196/68292"
}