P-090 - (Poster #90) Developing accessible and inclusive music-based support for chronic pain through telehealth

As practitioners seek to expand non pharmacological approaches to manage chronic pain, studies have shown that interdisciplinary, coordinated interventions across disciplines using multiple treatment strategies are effective. Music listening has been widely studied to address pain management, with proven reductions in self-reported pain, emotional distress, and opioid use. Furthermore, research on group music therapy for chronic pain indicates that these interventions effectively harness multiple mechanisms, in particular self-efficacy and social connectedness. However, many patients cannot access face-to-face music therapy due to their health conditions and/or socioeconomic barriers, and music therapy for this purpose may not be available in their area. Previously published research on telehealth with music therapy shows its effectiveness for individuals and groups with chronic pain. One study on support group applications focused on emergent use during the COVID-19 lockdown with attempts to replicate live music-making, which had limitations over video conferencing platforms. In other research on individual telehealth sessions for chronic pain patients reported benefits from guided imagery with music. This project builds on these findings by integrating their most effective features–social interaction, psychoeducation, music sharing and music and imagery– to co-design a telehealth support group with patients outside of the pressures of the COVID-19 pandemic.

Purpose/Objectives: Given the effectiveness of social connection with music therapy and initial findings of effective telehealth music therapy with this population, we worked with chronic pain patients to 1) co-develop a protocol for telehealth support groups that would best meet the needs of those who might otherwise not receive the benefits of group music therapy, and 2) evaluate relevance and acceptability of standard outcome measures recommended for chronic pain research. We will use the results of both aims to prepare us for further research and clinical trials.

Methods:

We collaborated with patients and providers from an osteopathic neuromusculoskeletal institute and conducted 3 cohorts of the Virtual Chronic Pain Support Group over one year to develop the session protocol and test the utility of outcome measures. Each cohort ranged in size from 2 to 6 members. We utilized a mixed methods approach, obtaining ongoing participant feedback via biweekly surveys and responsive session design to increase relevance and accessibility of programming. We facilitated focus groups at the conclusion of each cohort’s series of sessions and conducted thematic analysis of their data to identify themes regarding how the groups addressed participants’ needs and any additional suggestions/considerations for future groups. We also examined the feasibility of survey data collection methods and measures, including PROMIS measures SF-3a Pain Intensity, SF-4a Pain Interference, 5a Neuropathic Pain Quality, Psychosocial Illness Impact - Positive, SF-4a Self-efficacy for Managing Chronic Conditions - Managing Symptoms, and Global Health v. 1.2.

Results:

In response to ongoing participant feedback across each cohort, we modified the group protocol by extending the session length and changing the sequence of elements in each session. Survey and focus group data after each cohort’s series of sessions indicated that participants deeply valued the social connectedness of the sessions through talking, song sharing, and guided imagery with music. Participants also expressed clear preferences for session format and content, including small group size, inclusion of participant-centered psychoeducation, and centering song sharing and music and imagery experiences. Furthermore, participants reported that they used recordings of music and imagery experiences and playlists created by the group in between sessions to cope with their pain. Participants also reported increased beneficial involvement with music as an outcome of the groups, whether listening to or playing music, even when pain had caused them to cease their engagement with music in the past. Patients easily completed pre-test and post-test measures, however some biweekly surveys were not complete due to patients forgetting to respond or being unable to respond due to daily stressors and schedules. However participants reported they found the quantitative measures at all data points were relevant to their pain experience and needs.

Conclusions/Implications for future research and/or clinical care:

In summary, this group protocol designed in collaboration with patients has the potential to bring effective, nonpharmacological support to chronic pain patients with challenging needs. Participants found that the support groups were accessible and provided meaningful social connection to peers, in addition to offering beneficial psychoeducation and resources for self-managing pain in between sessions. Thus telehealth music support groups can be a lifeline for isolated pain patients facing barriers to face-to-face meetings, whether the cause of isolation is related to geographic location, physical limitations, or cost. Furthermore, telehealth sessions can more easily connect the limited number of trained music therapists with pain patients in need of these interventions, thus expanding the reach of music-based interventions. We will revise our data collection methods to address the challenges participants experienced regarding completing check-in surveys, perhaps implementing additional reminder systems and multiple methods of contact. We will develop training materials for this approach for additional practitioners and then conduct research with other patient communities alongside and in conjunction with compatible interventions to determine the most effective approaches for this difficult-to-treat population.