Volunteer Peer Support for Chronic Pain Self-Management: A Qualitative Study of Benefits and Barriers.

BACKGROUND

Pain self-management is a key ingredient in chronic pain management. Peer support has been shown to be effective in helping patients self-manage other chronic conditions and may be a promising approach to implementing pain self-management programs more broadly without placing additional demands on clinicians. The Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) trial tested peer-supported chronic pain self-management. Although peers may be paid staff or volunteers, the ECLIPSE intervention was delivered by volunteer peer coaches, to test a low-resource model that could be easily implemented if effective. Trial results showed no statistically significant differences between intervention and control participants on key outcomes, and intervention adherence was low.

OBJECTIVE

To understand participants' experiences with peer coaching to help explain trial results.

DESIGN

Semi-structured qualitative interviews with participants and peer coaches.

PARTICIPANTS

Veterans with chronic musculoskeletal pain.

KEY RESULTS

Benefits to intervention participation included connecting with fellow veterans, receiving encouragement and hope, and improving pain self-management. Peer coaches described benefits unique to their role: facilitating their own pain self-management, having a "positive distraction," and a sense of "giving back." Barriers included difficulties reaching participants; resistance to focusing on the curriculum, including prioritizing socializing and being unwilling to set pain management goals; and phone delivery, which impeded communication and rapport-building.

CONCLUSIONS

Participants described benefitting from the ECLIPSE intervention. Challenges, mostly related to engagement, were also described and may help explain trial results. The low-resource nature of the intervention may have exacerbated these difficulties. Volunteer coaches typically receive less training than paid peers and may have been less prepared to handle challenges; moreover, as volunteers, peer coaches likely had competing demands that left less time for coaching. Future research should seek to identify whom to target for peer-led versus other types of interventions to maximize benefit and use of resources.