Behavioral Treatments for Chronic Pain
|Intractable Pain||Behavioral: Cognitive-behavioral therapy Behavioral: Acceptance-based therapy|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Acceptance-Based Treatment for Chronic Pain|
- Brief Pain Inventory [ Time Frame: 12 weeks (post treatment) ]This questionnaire measures pain severity and interference. Scores range from 0-10, with higher scores indicating more pain.
- West Haven-Yale Multidimensional Pain Inventory - Activity Subscales [ Time Frame: 12 weeks (post treatment) ]This questionnaire measures levels of activity that can be affected by pain. Full measure has a range of 0-6, with higher scores indicating higher levels of activity.
- SF-12 [ Time Frame: 12 weeks (post treatment) ]This questionnaire measures quality of life. Scores range from 0 to 100, with higher scores indicating better quality of life.
- Beck Depression Inventory [ Time Frame: 12 weeks (post treatment) ]This questionnaire measures depressive symptoms. Scores range from 0 to 63, with higher scores indicating higher levels of depressive symptoms.
- Pain Anxiety Symptom Scale - 20 [ Time Frame: 12 weeks (post treatment) ]This questionnaire measures pain-related anxiety. Scores range from 0 to 100, with higher scores indicating higher levels of anxiety.
|Study Start Date:||October 2006|
|Study Completion Date:||September 2009|
|Primary Completion Date:||December 2008 (Final data collection date for primary outcome measure)|
Active Comparator: Cognitive Behavioral Therapy
8 group-administered sessions of Cognitive-Behavioral Therapy
Behavioral: Cognitive-behavioral therapy
8 group-administered sessions of Cognitive-Behavioral Therapy; includes relaxation, cognitive restructuring, and problem-solving
Other Name: CBT
Experimental: Acceptance-Based Therapy
8 group-administered sessions of Acceptance-based therapy
Behavioral: Acceptance-based therapy
8 group-administered sessions of Acceptance-based therapy; includes mindfulness, values, and committed action
Other Name: ACT
Chronic pain affects at least 15% of the veteran population and represents a high priority for the VA. In addition to primary pain conditions, chronic pain is a common secondary condition resulting from battlefield injuries, traumatic accidents, and congenital and acquired disorders. Unlike most forms of acute pain, treatment options available for patients suffering from chronic pain frequently offer only short-term or partial relief from symptoms. The focus of rehabilitative intervention thus becomes the reduction of disability and emotional distress and improvement in quality of life and activity levels.
Chronic pain rehabilitation has evolved from a primarily one-dimensional, medically oriented approach to a multidisciplinary approach that incorporates a biopsychosocial formulation to pain management with physiological, cognitive, behavioral, and emotional components. This conceptualization of pain recognizes that multiple intervention modalities, including psychosocial approaches, are required when providing treatment to chronic pain patients.
A relatively new psychosocial approach to chronic pain management and rehabilitation involves acceptance of pain-related experiences. The Acceptance-based Therapy (AT) model is based on the theory that attempts to escape, avoid, or control negative experiences that cannot be changed, such as chronic pain, may paradoxically contribute to the increased experience of them. Instead of seeking to control the negative experience, AT teaches individuals to use mindfulness strategies to enlarge the scope of experience beyond pain and to engage in behaviors that are consistent with personal values and goals when total elimination of pain or other negative experiences is not possible. Empirical support for acceptance-based approaches to chronic pain management is growing. Data from one of the first comparisons of AT to a well-established psychosocial intervention, Cognitive-Behavioral Therapy (CBT), performed at VASDHS by the PI, suggests that AT may be superior to CBT as an adjunctive treatment for chronic pain.
The proposed study assembles a multidisciplinary team with extensive experience in chronic pain interventions research to evaluate the benefits of a brief, manualized group-administered psychosocial intervention which could be easily integrated into multidisciplinary pain rehabilitation programs throughout the VA system to reduce disability in veterans with chronic pain secondary to other conditions. Specifically, we propose to examine the effects of a promising new chronic pain intervention based on AT principles on the primary outcome of pain interference and secondary outcomes of emotional distress, quality of life, physical activity, pain intensity, and treatment satisfaction among 94 veterans with chronic benign pain as a secondary condition. The AT intervention will be compared with treatment as usual (TAU) in a within-subjects design and with CBT in a randomized, between-subjects design. Outcomes include an objective measure of physical activity, actigraphy, as well as self-reported measures and will be evaluated at baseline, 6 weeks (after a TAU phase), 12 weeks (after treatment), and at a 6-month follow-up period to investigate maintenance of gains. The study design also allows for an investigation of hypothesized mechanisms of change, acceptance (for AT) and perceived pain control (for CBT). Thus, the proposed project has the potential to enhance the current VA standard of care as well as to add to the scientific literature on psychological models and rehabilitation of chronic pain.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00371865
|United States, California|
|VA San Diego Healthcare System, San Diego|
|San Diego, California, United States, 92161|
|Principal Investigator:||Julie L Wetherell, PhD||VA San Diego Healthcare System, San Diego|