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 this project, investigators 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. Investigators will conduct a pilot RCT (n=100) of older adults with chronic MSK pain. All participants will receive an introductory pain education video. Participants will be randomized to receive either RYD or a comparison intervention (health education videos). Investigators will examine RYD feasibility and acceptability as well as changes over time in outcomes (pain interference, depression, quality of life) and putative mediators.

Inclusion criteria

• Chronic MSK pain. Consistent with existing guidance, the experience of pain must be present most days of the week over the past 3 months, of at least moderate intensity.
• Pain interferes with everyday activities.
• Age 55 or older.
• Proficiency in English sufficient to engage in informed consent and understand assessments and materials.
• Reliable internet access.

Exclusion criteria

• Currently receiving acceptance/mindfulness or similar psychotherapy for chronic pain management.
• Current severe substance use problems.
• Cognitive impairment that would interfere with a person's capacity to complete the study.