Using social media to challenge unwarranted clinical variation in the treatment of chronic noncancer pain: the “Brainman” story

There is a substantial clinical variation in the contemporary treatment of chronic noncancer pain reflecting different explanatory models and treatment emphasis. Hunter Integrated Pain Service and collaborators developed three key messaging videos outlining the foundations of chronic pain treatment, thus challenging unwarranted clinical variation and calling for greater therapeutic consistency. The videos were released on YouTube as a low-cost public health intervention. Each video used an evidenced informed script appropriate for low literacy and a cartoonist to provide matching images. The whole-person approach emphasized the role of the nervous system and active self-management approaches over passively received medical treatments. The first video was launched on YouTube in August 2011 and made freely available through a Creative Commons license. Multisource feedback led to refinement of key messages using a broader advisory group. Two further videos were launched on a dedicated YouTube channel in October 2014 and circulated through varied professional and consumer networks. All videos were widely viewed on YouTube, utilized by diverse health care organizations, and independently translated into multiple languages. They were embedded in multiple health-related websites. The first video "Understanding pain in less than 5 minutes" is known to have been translated into 15 languages by other health care organizations. The subsequent two videos (Brainman stops his opioids, and Brainman chooses) were translated into German and subtitled in French and Japanese. When the organization hosting the first video ceased operation in 2015 due to changes in primary health care funding, the video had received >700,000 views. Each of the three videos continues to receive ~1,500 views per month on YouTube. Release of evidence-informed key messages via YouTube is a simple method of challenging clinical variation and providing education about chronic pain across the health care system and community.