Development and preliminary testing of a peer narrative video intervention for older adults with chronic pain

Chronic musculoskeletal (MSK) pain, which includes spinal pain, osteoarthritis, and fibromyalgia, is a common and costly problem for older adults and is associated with decreased quality of life. There is a clear need for interventions that increase one’s ability to cope with chronic pain and engage in meaningful life activities even

with the presence of chronic pain. Acceptance and Commitment Therapy (ACT) is a psychotherapy that uses mindfulness and psychological acceptance to support individuals in working toward behavioral goals guided by their personal values, even in the presence of undesirable experiences such as chronic pain. Clinical practice

guidelines recommend the use of ACT for treating chronic pain based on evidence of effectiveness from multiple RCTs. However, uptake and reach are limited because there are insufficient numbers of mental health professionals who currently offer ACT or other recommended therapies (e.g., cognitive-behavioral therapy) for

chronic pain. In addition, many older adults are not willing or able to engage in traditional psychotherapy for chronic pain even when it is available. Although some bibliotherapy and digital health interventions (e.g., apps) have been developed for treating pain, many older adults fail to use them due to low levels of comfort with

technology or lack of motivation for intensive self-guided approaches. Narrative communication is an alternative way to deliver behavior change principles that involves “storytelling” involving real patients talking about their struggles and recovery progress. Therapeutic narratives delivered via videos may be more

engaging and immersive than traditional self-help formats for older adults. In previous grant-funded research, our team has developed methods for creating narrative, video-based interventions designed to reduce depression in primary care patients and prevent suicide in patients following a psychiatric hospital. Thus, in this

project, we propose to create Reclaim Your Day (RYD), which will consist of 6, 30-min weekly video episodes highlighting patients’ inspiring and illustrative experiences living with chronic pain in order to teach current patients with chronic MSK pain how to apply ACT’s evidence-based strategies. In Phase 1 of this project, we

will interview older adults with chronic MSK pain about their coping history, and code interviews for consistency with ACT principles. We will invite a subset of these individuals to work with a professional storytelling coach to develop and videorecord their ACT-consistent stories. These documentary-style videos that will form the basis

of RYD. In Phase 2, we will conduct a pilot RCT (n=100) of older adults with chronic MSK pain. All participants will receive a 30-min introductory pain education video. Participants will be randomized to receive either RYD or a comparison intervention (health education videos). We will examine RYD feasibility and acceptability as

well as changes over time in outcomes (pain interference, depression, quality of life) and putative mediators.