WSU researchers say new approach reduces pill use
By LeAnn Bjerken – originally published in the Journal of Business
Dr. Marian Wilson, a second-year assistant professor at Washington State University Spokane, found in a study on chronic pain that women seem more open than men to participating in studies and sharing their symptoms.
“To me, it’s a very positive thing, seeing this amount of women who are willing to participate in open discussions of chronic pain,” says Wilson. “At the same time, it makes me worry about the men, as they don’t seem to be as receptive to this kind of thing.”
She completed a doctorate in nursing at WSU in July 2013 and published her dissertation, a research study titled, “Empowering Patients with Persistent Pain Using an Internet-based Self-Management Program.”
Wilson says the pain study didn’t research the effect of opiods on pain. Rather, it took into account whether people on opiods could engage in an online program and whether they had any change in their use of opiods as a result of participating in the study.
“We haven’t quite caught up with how to use methods other than pills to relieve pain,” says Wilson. “This study was partly about how to help these people transition from reliance on opioids, to using other, less harmful, less addictive ways to manage pain on a daily basis.”
Wilson says the content of her study’s Internet-based self-management program involved techniques for pain management that have been shown to work.
“Some of these techniques were about changing thinking patterns. Others were meditation or relaxation techniques,” says Wilson. “Basically we wanted to create a toolbox.”
She describes these tools as things a patient can use to help themselves, before considering medication.
The study began in January 2012 as an eight-week online intervention, and the research portion wrapped up in March 2013. Of the 114 potential participants recruited for the study, 92 were selected and completed the study fully.
Participants were divided into a treatment and a control group of about 45 each, and 78 percent of all those who participated were female. Wilson says that could be due to several factors, the first being that certain chronic pain conditions are more commonly found in women.
“Conditions like fibromyalgia, and recurring symptoms like migraines and back pain are some of the top listed by patients who suffer from chronic pain,” says Wilson. “Similarly, these are also conditions we know to more commonly affect women.”
Wilson says women also seem more willing to participate in self-help studies—or those that involve the use of psychological techniques.
“Women do seem more receptive to self-help types of studies. When we suggest cognitive therapy, many people get concerned we’re suggesting the pain is all in their head,” says Wilson. “We want to help them recognize that while the pain is physical, there are psychological techniques that can help.”
She says another reason people might be reluctant to sign up for these types of studies are the societal and cultural stigmas attached to psychological help.
“Part of it is upbringing and societal expectations,” says Wilson. “I wouldn’t say the results of this study mean men don’t experience chronic pain; rather, I think it’s quite possible they’re suffering silently because they feel that societal pressure to appear strong.”
Eligibility criteria for the study dictated participants must be individuals 18 or older who identified as having had non-cancer chronic pain lasting more than three months, had current prescriptions for opioid medicine, as well as Internet access and the ability to read, speak, and write English. Individuals were excluded in cases of upcoming planned surgical treatment, pregnancy, or current participation in therapy for substance abuse.
As part of the study, participants also were required to document their use of opioid medications, specifically whether they were using them as prescribed, taking more than prescribed, or taking pills more frequently than prescribed.
“In an effort to get some relief, patients end up taking more than they need and overdosing,” says Wilson. “Soon, some of these patients are taking pills for reasons other than pain and what was once a relief starts to become a physical addiction.”
The study reports that of the more than 15,000 annual deaths in the United States from opioid overdose, 60 percent occur in patients who had obtained the medications through legitimate prescriptions.
“When we see a pill as the chosen solution to pain, we’re dismissing a lot of other alternatives that could save lives,” says Wilson.
The study concluded that patients on opioids were able to engage and demonstrate positive outcomes using the Internet-based self-management program. Wilson says some participants, having learned and begun to practice healthier options such as meditation, relaxation, and positive thinking, reported a decrease in their use of opioids.
“Unique to our study was the discovery that more appropriate use of opioid medicines could be an unintended consequence of participation,” says Wilson. “There is more and more evidence coming out that if we can get them off the opiates or reduce their use and help them become more active, that they’ll begin to feel better.”
Wilson says that participants reported the meditation and relaxation techniques to be the most helpful tools in helping them to manage pain. She also notes that chronic pain and depression often are linked, a connection she wants to continue to explore in future studies.
“It’s about breaking thought patterns, replacing catastrophic thinking with helpful thoughts and planning what to do differently on a bad pain day,” she says.
Wilson is board certified in pain management nursing through the American Nurses Credentialing Center and the American Society for Pain Management Nursing. She teaches six classes at WSU Spokane and handles some online instruction.
“A lot of my courses are taught through videoconferencing, so I’m very in tune with this kind of online connection,” says Wilson.
Originally from New Jersey, Wilson earned bachelor degree in psychology from Indiana University in Bloomington, Ind., then earned an associates degree in nursing from Gloucester County College, in Sewell, N.J. Wilson earned her Masters in Public Health at University of Massachusetts, Amherst, Mass.
Wilson has lived in Idaho for the last 20 years, having spent 15 of those at Kootenai Medical Center in Coeur d’Alene, working with cancer patients. “I think the years I spent working with those patients was the time I really began to develop an interest in pain, what causes it and how to we might go about treating it more effectively” says Wilson.
Wilson’s co-authors in the study are John Roll, WSU Spokane senior vice chancellor and principal investigator, and fellow Spokane-based nursing faculty members Cynthia Corbett and Celestina Barbosa-Leiker. The study was funded by the Washington State Life Sciences Discovery Fund.
Having studied under the guidance of Roll within the rural mental health and substance abuse treatment, Wilson’s focus now is on how mood disorders, opioid dependency, misuse, and addiction can be addressed within persistent pain populations with a focus on adopting nonpharmacological strategies.
Currently Wilson is working to replicate the first study’s findings, through a new study with the Spokane Regional Health District, this time involving a new group of participants from one of the area’s methadone clinics.
“It will be interesting to see how many of these patients report having addictions that started as a legal prescription and transformed into a dependence on the drug,” Wilson says. While she and her colleagues are almost done recruiting for the online depression program, which has mostly female participants, they have just begun recruiting for the methadone clinic study, which so far has a fair number of men inquiring.