Comparison of a Single-Session Pain Management Skills Intervention With a Single-Session Health Education Intervention and 8..., 2021, Darnal et al

Full title: Comparison of a Single-Session Pain Management Skills Intervention With a Single-Session Health Education Intervention and 8 Sessions of Cognitive Behavioral Therapy in Adults With Chronic Low Back Pain, A Randomized Clinical Trial


Question Is a single-session pain relief class noninferior to 8 sessions of cognitive behavioral therapy (CBT) at 3 months after treatment?

Findings In this 3-arm randomized clinical trial that included 263 adults with chronic low back pain, a single-session pain management skills class was noninferior to 8 weeks of CBT and superior to a health education class for pain catastrophizing and multiple secondary outcomes at 3 months after treatment.

Meaning For patients with chronic low back pain, a single-session pain relief skills class showed comparable efficacy to CBT in pain catastrophizing, pain intensity, and pain interference and other outcomes at 3 months after treatment.


https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783047

 

Will probably get lost in the storm of NICE's caving, but this appears to be the PACE trial of CBT for lower back pain.

It tests what it calls "Empowered relief" (trademarked, of course), which seems to be a commercial product a bit similar to LP, though with less cultist vibes. A single session here shows "reductions" across the board on several psychosocial and symptomatic self-ratings, from fatigue to pain, however the primary outcome was "pain catastrophizing".

The benefits shown on pain, a secondary outcome here, appear relatively low and subject to several biases. Of course impossible to tell whether the changes are 1) artificial, 2) related to perception or 3) related to reporting.

What this is shows is that 1-hour "course", which "teaches skills" (gamification appears to be a big thing nowadays, you are upgrading!) is better than several sessions of face-to-face CBT at either of changing reporting, perception, or just fudging the results by manipulating the participants.

I was alerted to this trial by a glowing near informercial-level of promotion by Stanford Medicine (and oh wow Stanford itself is developing it and appears to be using it as an income source: https://empoweredrelief.stanford.edu/): https://scopeblog.stanford.edu/2021...relieves-chronic-low-back-pain/?sf149080985=1. It shows a similar process to what is happening with Mahana and their CBT for IBS app, including creating a significant business empire out of it:

Now, Darnall's team is expanding access to the Empowered Relief program to help address existing disparities in pain care. The class is already available in five languages and seven countries to treat chronic pain -- and the team has certified 300 healthcare clinicians around the world as Empowered Relief instructors.​

Given that this falls in line with the other identical trials of its type, this is likely of interest to you, @dave30th.

 

You mean it has taken until 2021 to do a trial on the treatments proposed by Arthur Cott in 1985.

 

$10.3M awarded for this junk study. This is scandalous. There have been dozens, if not hundreds, of those trials already. Adding another BS pseudoscientific comparison changes nothing at all, it's exactly equivalent to swapping homeopathic treatment, water vs. water. I don't even know how it could be possible to spend over $10M on this, it's 100% online, is very low effort. I don't even know how to spend $1M on this, it's deliberately inflating the cost to create a sunk cost, exactly like with PACE.

And to have the nerve to pretend that this is what patients want. This is explicitly abusing patient involvement for their own purpose, there is exactly zero chance that an open discussion lead to this.

https://twitter.com/user/status/1467552799579729924


And this has exactly zero to do with that, a complete sham of fake patient engagement:

https://twitter.com/user/status/1467553221623394314


This is not serious, it's not something that needs to be understood, it's a setup with a manufactured outcome, you don't spend $10M pushing something for it to fail:

https://twitter.com/user/status/1467553725271003141


Again, $10M for this, how? Spent on what?!

https://twitter.com/user/status/1467553809245229064

 

Oh, forgot: @dave30th, the empire is expanding.

 

It's sold as a "mind-body intervention" and the tagline is literally "Train your brain away from pain", but OK. Woo for everyone, then! Frankly pretty much appears to be the same stuff as LP, it's also a commercial product hidden behind a paywall. As explained in the first paper:

So something that includes CBT is... noninferior to CBT. And of course:

Useless as an outcome. It's the same formula, with the same intent. So, no, it may not actually be a bit useful, because we all know how this ends and that the sole intent is cost-saving. Even has the same assumptions as PACE:

 

My partner's response to your comment was "so everyone's a winner; patients now only suffer through 2 hours of B***S*** instead of 16 and Darnell et al. make loads of money on Zoom calls!"

 

This whole system works by showing patients that they are being fobbed of by their doctors and in order not to waste their doctors time or their own time . they may as well forget the medical profession exists as an option for them .