Commentary

This study by LeFort et al is the first to indicate that a nurse led community educational programme can be effective in the treatment of chronic idiopathic pain. Its strengths derive from attention to detail in the research design: it was based on a theoretical framework which distinguished antecedent and mediating variables from outcome variables; tests of validity and reliability for the self reported measures were provided; the randomisation procedure was robust; assessments were conducted blind; attrition was negligible; findings were based on intention to treat analyses; and type 1 errors were minimised. In terms of potential weaknesses, the authors recognised that a single facilitator may have influenced treatment effects and note that direct comparisons with other studies are difficult. It was assumed in the design of the study that being on a waiting list was a neutral condition for the purposes of control, whereas it is possible that this sustained hope and suspended coping activities. Although the research assistant was blind to the treatment condition when assessing outcomes at the end of the study, the participants, unlike those in drug trials, were not and this could have affected control group reporting.

The researcher relied on statistically significant rather than clinically significant outcomes, which are more conservative.¹ The long term effects of the programme and the need for booster sessions to maintain self management should be evaluated in view of the many intervening variables that could interfere with sustained effects. Assessment strategies need to be developed to predict which people are most likely to benefit from such a programme and to devise follow up strategies to maintain self help behaviours and improvements in quality of life.

Nurses who work in pain clinics where multidisciplinary teams do not exist, as well as those who work in primary care settings, should try to replicate this programme using similar outcome measures and incorporating economic analyses.