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.