Use of Self-management Interventions for Chronic Pain Management: A Comparison between Rural and Nonrural Residents.
Linda H Eaton, Dale J Langford, Alexa R Meins and 3 others
PMID 29153296WHAT IT FOUND
Rural adults with chronic pain reported using non-medicine pain strategies less often than non-rural adults: 77% versus 92%.
Opioid use was higher in rural adults, but that difference was not significant.
Key findings
01Rural residents used non-medicine self-management interventions less often than non-rural residents: 77% versus 92%, and the study reported this difference as significant (p = 0.019).
02Opioid analgesics were taken by 76% of rural residents and 52% of non-rural residents, but the difference was not significant after accounting for clustering by clinic.
03About 20% of participants taking opioids were on high dose opioids, defined as more than 120 MED per day, regardless of rural or non-rural residence.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a secondary analysis of baseline data, not a randomized comparison of rural and non-rural treatment. Rural status was not assigned, so differences cannot be proven to be caused by rurality. The analysis used a subset of a trial sample, based on who had self-management data, which may limit generalisability. Self-management use and opioid dose came from an investigator-developed questionnaire and patient report. The questionnaire focused on interventions patients could do independently. Interventions needing a clinician, such as physical therapy, were only captured if listed as other, so use of clinician-delivered treatments may be underestimated. The sample was predominantly Caucasian, so it may not apply to more diverse populations. The opioid difference was not statistically significant after accounting for clustering by clinic, so it should not be read as a confirmed disparity. The paper does not report measurements that would show why rural residents used fewer self-management interventions.
Declared interests
No author conflict-of-interest declaration or funding statement appears in the supplied text; the publication types list NIH extramural research support.
The easy way to misread this
Do not conclude that rural patients use fewer self-management interventions because they cannot access them, or that nurse education will increase their use. The study only compared self-reported baseline use in rural and non-rural groups and did not test access, interventions, or outcomes. Do not read the 76% versus 52% opioid difference as proven; it was not statistically significant after accounting for clinic clustering.