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Aaron RV, Ravyts SG. Harnessing spectra of pain psychology treatment design to improve patient access to care. Pain Rep 2024; 9:e1. [PMID: 38586594 PMCID: PMC10994470 DOI: 10.1097/pr9.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/14/2024] [Indexed: 04/09/2024] Open
Abstract
Commentary on: Darnall BD, Burns JW, Hong J, Roy A, Slater K, Poupore-King H, Ziadni MS, You DS, Jung C, Cook KF, Lorig K, Tian L, Mackey SC. Empowered relief, cognitive behavioral therapy and health education for people with chronic pain: a comparison of outcomes at 6-month follow-up for a randomized controlled trial. PAIN Reports 2024;9:e1116.
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Affiliation(s)
- Rachel V. Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Scott G. Ravyts
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Newman AK, Thorn BE. Intersectional identity approach to chronic pain disparities using latent class analysis. Pain 2022; 163:e547-e556. [PMID: 34252906 DOI: 10.1097/j.pain.0000000000002407] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Research on intersectionality and chronic pain disparities is very limited. Intersectionality explores the interconnections between multiple aspects of identity and provides a more accurate image of disparities. This study applied a relatively novel statistical approach (ie, Latent Class Analysis) to examine chronic pain disparities with an intersectional identity approach. Cross-sectional data were analyzed using pretreatment data from the Learning About My Pain trial, a randomized comparative effectiveness study of group-based psychosocial interventions (Patient-Centered Outcomes Research Institute Contract #941, Beverly Thorn, PI; clinicaltrials.gov identifier NCT01967342) for patients receiving care for chronic pain at low-income clinics in rural and suburban Alabama. Latent Class Analysis results suggested a 5-class model. To easily identify each class, the following labels were created: older adults, younger adults, severe disparity, older Black or African American, and Working Women. The latent disparity classes varied by pretreatment chronic pain functioning. Overall, the severe disparity group had the lowest levels of functioning, and the Working Women group had the highest levels of functioning. Although younger and with higher literacy levels, the younger adults group had similar levels of pain interference and depressive symptoms to the severe disparity group (P's < 0.05). The younger adults group also had higher pain catastrophizing than the older adults group (P < 0.005). Results highlighted the importance of the interactions between the multiple factors of socioeconomic status, age, and race in the experience of chronic pain. The intersectional identity theory approach through Latent Class Analysis provided an integrated image of chronic pain disparities in a highly understudied and underserved population.
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Affiliation(s)
- Andrea K Newman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Beverly E Thorn
- Department of Psychology, University of Alabama, Tuscaloosa, AL, United States
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Examination of mechanism effects in cognitive behavioral therapy and pain education: analyses of weekly assessments. Pain 2021; 162:2446-2455. [PMID: 34448755 DOI: 10.1097/j.pain.0000000000002237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/07/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Psychosocial treatments for chronic pain produce favorable outcomes. However, we still do not know precisely by what mechanisms or techniques these outcomes are wrought. In secondary analyses of a 10-week group intervention study comparing the effects of literacy-adapted cognitive behavioral therapy (CBT) with literacy-adapted pain education (EDU) among patients with chronic pain, low-socioeconomic status, and low literacy, the Learning About My Pain trial, we examined whether pain catastrophizing was a mechanism specific to CBT. Participants (N = 168) completed mechanism and outcome measures weekly for the 10 weeks of group treatment. Analyses revealed that (1) pain catastrophizing was reduced similary across CBT and EDU; (2) lagged analyses indicated that previous week reductions in pain catastrophizing predicted next week reductions in pain intensity and pain interference; (3) cross-lagged analyses indicated that previous week reductions in pain intensity and interference predicted next week reductions in pain catastrophizing; and (4) the relationships between pain catastrophizing and pain intensity and interference were moderated by session progression such that these links were strong and significant in the first third of treatment, but weakened over time and became nonsignificant by the last third of treatment. Results suggest the existence of reciprocal influences whereby cognitive changes may produce outcome improvements and vice versa. At the same time, results from analyses of changes in slopes between pain catastrophizing and outcomes indicated that CBT and EDU were successful in decoupling pain catastrophizing and subsequent pain intensity and interference as treatment progressed. Results provide further insights into how psychosocial treatments for chronic pain may work.
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The Effect of Literacy-Adapted Psychosocial Treatments on Biomedical and Biopsychosocial Pain Conceptualization. THE JOURNAL OF PAIN 2021; 22:1396-1407. [PMID: 34004347 DOI: 10.1016/j.jpain.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 03/03/2021] [Accepted: 04/04/2021] [Indexed: 11/22/2022]
Abstract
This is a secondary data analysis of a subgroup of participants who received the Learning About My Pain (LAMP) intervention (clinicaltrials.gov identifier NCT01967342). We examined the effects of LAMP on pre-to-post changes in biomedical and biopsychosocial pain conceptualization and whether those changes in pain conceptualization were associated with physical and psychological functioning. Participants were randomized into three conditions: Cognitive Behavioral Therapy (CBT), Pain Psychoeducation (EDU), or Usual Medical Care (UC). Results based on 225 participants who completed the Pain Concepts Questionnaire (PCQ) showed a pre-to-post reduction in biomedical pain conceptualization (BM), an increase in biopsychosocial pain conceptualization (BPS), and an increase in BPS/BM ratio for CBT and EDU but not UC. There were no differences between CBT and EDU in post-treatment PCQ scores. Compared to those with lower BM pain beliefs scores at post-treatment, participants endorsing higher BM pain beliefs scores reported greater pain intensity and greater pain interference. Furthermore, higher BM pain beliefs scores at post-treatment and lower BPS/BM ratio were associated with higher levels of pain catastrophizing. Overall, results of this study suggest the need for targeting specific pain beliefs that influence pain-related outcomes. PERSPECTIVE: This article presents the potential benefits of providing literacy-adapted psychosocial treatments to expand pain conceptualization beyond a biomedical-only understanding and toward a biopsychosocial conceptualization of the experience of pain. Furthermore, the association of changes in pain conceptualization and pain-related functioning argues for its potential clinical relevance.
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Ronald Melzack Award Lecture: Putting the brain to work in cognitive behavioral therapy for chronic pain. Pain 2021; 161 Suppl 1:S27-S35. [PMID: 33090737 DOI: 10.1097/j.pain.0000000000001839] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Scott W, Guildford BJ, Badenoch J, Driscoll E, Chilcot J, Norton S, Kemp HI, Lee MJ, Lwanga J, Boffito M, Moyle G, Post FA, Campbell L, Josh J, Clift P, C de C Williams A, Rice AS, McCracken LM. Feasibility randomized-controlled trial of online acceptance and commitment therapy for painful peripheral neuropathy in people living with HIV: The OPEN study. Eur J Pain 2021; 25:1493-1507. [PMID: 33711209 DOI: 10.1002/ejp.1762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/06/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Neuropathic pain negatively affects quality of life among people living with HIV (PLWH). This study examined the feasibility of conducting a full-scale randomized-controlled trial of online acceptance and commitment therapy ("ACT OPEN") for neuropathic pain in PLWH. METHODS Using a parallel-groups design, thirty-eight participants were randomized to ACT OPEN or a waitlist control (2:1). Participants completed standard self-report outcome measures at baseline, and two- and five-months post-randomization. Participants were aware of their allocation, but assessment was blinded. RESULTS Twenty-five participants were randomized to ACT OPEN and 13 to the control (of 133 referrals). ACT OPEN completion was 69% and two-month trial retention was 82%. Treatment credibility and satisfaction scores for ACT OPEN were comparable to scores reported in previous trials of cognitive-behavioural treatments for pain. Four adverse events were reported during the study, including one serious adverse event; all of these were unrelated to the research procedures. Small to moderate effects and 95% confidence intervals suggest that the true effect may favour ACT OPEN for improvements in pain intensity/interference and depression. CONCLUSIONS A full-scale RCT of online ACT for pain management in PLWH may be feasible with refinements to trial design to facilitate recruitment. SIGNIFICANCE Research on pain management in people living with HIV has primarily focused on pharmacological treatments with limited success. This is the first study to show the potential feasibility of a psychological treatment based on acceptance and commitment therapy delivered online and tailored for pain management in people with HIV ("ACT OPEN"). ACT OPEN may be a promising treatment in this population and further evaluation in a full-scale randomized-controlled trial appears warranted. TRIAL REGISTRATION The trial was registered (clinicaltrials.gov; NCT03584412).
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Affiliation(s)
- Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,INPUT Pain Management Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Beth J Guildford
- Dental Psychology Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Badenoch
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Elizabeth Driscoll
- INPUT Pain Management Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Joseph Chilcot
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Harriet I Kemp
- Pain Research Group, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Ming J Lee
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Julianne Lwanga
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Graeme Moyle
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Frank A Post
- Caldecot Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Lucy Campbell
- Caldecot Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Jo Josh
- UK Community Advisory Board, London, UK
| | | | - Amanda C de C Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Andrew Sc Rice
- Pain Research Group, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
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Kamran Ehsan M, Rowland DL. Possible Role for Imagery-Based Therapy in Managing PTSD in Pakistani Women Experiencing Domestic Abuse: A Pilot Study Using Eidetic Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052478. [PMID: 33802328 PMCID: PMC7967602 DOI: 10.3390/ijerph18052478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 11/24/2022]
Abstract
Domestic abuse of women is a serious problem worldwide that has economic, physical, and psychological consequences, yet in many countries and cultures, victims often have little access to psychological support. Using a pre-post design, we investigated the effects of psychological intervention using an imagery-based therapy in women showing post-traumatic stress disorder (PTSD) resulting from spousal domestic abuse. Forty women, referred from outpatient clinics in Pakistan and meeting inclusion criteria, underwent individual trauma counseling for 10–12 weeks using the principles of Eidetic Therapy, an imagery-based therapy that circumvents heavy reliance on verbal skills and narratives. Women showed significant reductions in PTSD by the end of treatment. Predictors of treatment gains included type of abuse, PTSD level at the outset of therapy, and years in the relationship. Neither economic resources or literacy, nor abuser or victim characteristics, predicted the amount of improvement. In conclusion, therapy was associated with a reduction in PTSD symptoms regardless of literacy level of participants. This reduction in PTSD was notable because, unlike many situations involving spousal abuse, these women were generally not in a position to leave their relationship, and hence the women might have experienced continued exposure to abuse. Context/cultural-based explanations for these findings are presented and discussed.
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Affiliation(s)
- Mehwish Kamran Ehsan
- Department of Professional Psychology, Bahria University, Islamabad 44000, Pakistan;
| | - David L. Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN 46383, USA
- Correspondence:
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Cole CL, Waterman S, Hunter ECM, Bell V, Greenberg N, Rubin GJ, Beck A. Effectiveness of small group cognitive behavioural therapy for anxiety and depression in Ebola treatment centre staff in Sierra Leone. Int Rev Psychiatry 2021; 33:189-197. [PMID: 32301358 DOI: 10.1080/09540261.2020.1750800] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Following the 2014 Ebola outbreak, South London and Maudsley NHS Foundation Trust (SLAM) were commissioned to provide a 'culturally appropriate, effective and sustainable' intervention to address the psychological needs of the Sierra Leonean Ebola Treatment Centre (ETC) staff. The study evaluated the effectiveness of group Cognitive Behavioural Therapy (CBT) developed to treat anxiety, depression and functional impairment amongst a sample of former ETC staff in Sierra Leone. Group comparisons explored whether the effect of the intervention differed dependent on the facilitators that delivered it, as well as whether it differed between former staff of high- and low-risk ETC roles. A sample of 253 former ETC staff attended the group CBT intervention comprised of eight sessions over six weeks. Outcome measures were administered upon entry and within two weeks after the intervention. At post-intervention, anxiety, depression and functional impairment significantly reduced. Reading ability (RA) was introduced as a covariate having impacted the outcomes. The intervention effect differed by facilitators delivering the sessions but not by ETC role risk. The implications of these results are discussed. Group CBT is a promising psychological intervention for treating the anxiety, depression and functional impairment of former ETC staff in Sierra Leone. Furthermore, as part of a stepped-care approach, it may provide a model for psychological support for staff that have worked on the frontline during future epidemics.
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Affiliation(s)
- Charles L Cole
- South London and Maudsley NHS Foundation Trust, London, UK.,Division of Psychiatry, University College London, London, UK
| | | | | | - Vaughan Bell
- South London and Maudsley NHS Foundation Trust, London, UK.,Division of Psychiatry, University College London, London, UK
| | - Neil Greenberg
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - G James Rubin
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Alison Beck
- South London and Maudsley NHS Foundation Trust, London, UK
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Harkness A, Rogers BG, Puccinelli M, Ivardic I, Ironson G, Safren SA. Engaging, retaining, and providing transdiagnostic integrated cognitive-behavioral therapy and motivational interviewing for underserved people with HIV. ACTA ACUST UNITED AC 2019; 57:15-22. [PMID: 31855041 DOI: 10.1037/pst0000270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
People with HIV experience elevated levels of co-occurring psychosocial concerns, which can interfere with HIV-related self-care behaviors, such as medication adherence. We recently developed transdiagnostic, integrated cognitive-behavioral therapy and motivational interviewing psychotherapy to address interrelated psychosocial problems (syndemics) that can interfere with medication adherence and self-care among people with uncontrolled HIV (i.e., a detectable viral load). Through completion of a field trial that included development, clinical supervision, treatment, and administrative coordination of this project, we identified recommendations for engaging, retaining, and delivering transdiagnostic cognitive-behavioral therapy/motivational interviewing to individuals with HIV and experiencing psychosocial and structural barriers to mental and physical health. We describe these recommendations, which include (a) building the relationship; (b) addressing HIV in the context of syndemics; (c) attending to the impact of stigma on health; (d) being flexible in delivering the treatment; (e) managing emergent crises with relevant skill material; (f) tailoring the treatment to education, language, and sociocultural context; (g) implementing problem-solving skills for structural barriers; (h) scheduling flexibly and following up; (i) colocating mental health services and coordinating among providers; and (j) providing a comfortable and affirming physical space. In addition to describing these recommendations, we provide clinical examples and highlight empirical research to illustrate and support using these recommendations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Heterogeneity of Treatment Effects in a Randomized Trial of Literacy-Adapted Group Cognitive-Behavioral Therapy, Pain Psychoeducation, and Usual Medical Care for Multiply Disadvantaged Patients With Chronic Pain. THE JOURNAL OF PAIN 2019; 20:1236-1248. [DOI: 10.1016/j.jpain.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/16/2019] [Accepted: 04/16/2019] [Indexed: 12/17/2022]
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Considerations of trial design and conduct in behavioral interventions for the management of chronic pain in adults. Pain Rep 2018; 4:e655. [PMID: 31583335 PMCID: PMC6749925 DOI: 10.1097/pr9.0000000000000655] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/17/2018] [Accepted: 03/21/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction A growing number and type of nonpharmacological approaches for the management of chronic pain have demonstrated at least modest evidence of efficacy, and for some, there is emerging evidence of their effectiveness in relatively large scale trials. Behavioral approaches are those that generally seek to promote adaptive behavioral change in the service of reducing pain and improving physical and emotional functioning and quality of life. Despite a substantial empirical literature supporting the clinical utility of these approaches, a large number of unanswered questions remain and clinical trials to answer some of these questions are needed. Although considerations for development and enactment of data-analytic plans are generally similar to those in pharmacological trials (eg, intent-to-treat, prespecifying outcomes and time points, and handling of missing data), there may be some important differences to consider when planning and conducting clinical trials examining these behavioral approaches. Objectives The primary objective of this article is to describe some aspects of clinical trials for behavioral approaches for the management of chronic pain that requires special consideration. Methods Important topics discussed include: (1) intervention development, (2) research design considerations (adequate and appropriate control and comparison conditions), (3) appropriate outcomes, (4) recruitment and sampling biases and blinding, (5) intervention fidelity and adherence, and (6) demographic and cultural considerations. Results and Conclusions A number of methodological recommendations are made in the service of encouraging the conduct of high-quality research comparable with that performed for pharmacological and other medical interventions.
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Waterman S, Hunter ECM, Cole CL, Evans LJ, Greenberg N, Rubin GJ, Beck A. Training peers to treat Ebola centre workers with anxiety and depression in Sierra Leone. Int J Soc Psychiatry 2018; 64:156-165. [PMID: 29432085 DOI: 10.1177/0020764017752021] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Following the 2014 Ebola virus disease (EVD) outbreak in West Africa, the UK Department for International Development funded South London and Maudsley National Health Service (NHS) to develop a psychological intervention that ex-Ebola Treatment Centre (ETC) staff could be trained to deliver to their peers to improve mental health in Sierra Leone. AIM The two key aims were to assess the feasibility of training a national team to deliver a cognitive behavioural therapy (CBT)-based group intervention, and to evaluate the effectiveness of the overall intervention within this population. METHODS UK clinicians travelled to Sierra Leone to train a small team of ex-ETC staff in a three-phased CBT-based intervention. Standardised clinical measures, as well as bespoke measures, were applied with participants through the intervention to assess changes in mental health symptomology, and the effectiveness of the intervention. RESULTS The results found improvements across all factors of mental health in the bespoke measure from phase 1 to phase 3. Additionally, the majority of standardised clinical measures showed improvements between phase 2 and the start of phase 3, and pre- and post-phase 3. CONCLUSION Overall, the findings suggest that it is possible to train staff from ETCs to deliver effective CBT interventions to peers. The implications of these results are discussed, including suggestions for future research and clinical intervention implementation within this population. The limitations of this research are also addressed.
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Affiliation(s)
| | | | - Charles L Cole
- 2 Division of Psychiatry, University College London, London, UK
| | | | - Neil Greenberg
- 3 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - G James Rubin
- 3 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alison Beck
- 1 South London and Maudsley NHS Foundation Trust, London, UK
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The relationship of sociodemographic and psychological variables with chronic pain variables in a low-income population. Pain 2017; 158:1687-1696. [DOI: 10.1097/j.pain.0000000000000964] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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DeMonte CM, DeMonte WD, Thorn BE. Future implications of eHealth interventions for chronic pain management in underserved populations. Pain Manag 2015; 5:207-14. [DOI: 10.2217/pmt.15.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
SUMMARY Many underserved communities, especially those in rural settings, face unique challenges that make high quality healthcare less accessible. The implementation of eHealth technologies has become a potentially valuable option to disseminate interventions. The authors’ work in rural Alabama Federally Qualified Health Centers provide insights into the access to technology as well as the likelihood of utilizing eHealth technology in underserved communities. This paper will review current challenges related to digital dissemination of behavioral health interventions for chronic pain. Two major concerns are the lack of technological resources and the lack of appropriate materials for patients who may have low levels of reading, health and/or digital literacy. We will propose some recommendations to address common barriers faced by those providing care.
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Affiliation(s)
- Colette M DeMonte
- The University of Alabama, 348 Gordon Palmer Hall, 505 Hackberry Lane, Tuscaloosa, AL 35487-0348, USA
| | - William D DeMonte
- The University of Alabama, 348 Gordon Palmer Hall, 505 Hackberry Lane, Tuscaloosa, AL 35487-0348, USA
| | - Beverly E Thorn
- The University of Alabama, 348 Gordon Palmer Hall, 505 Hackberry Lane, Tuscaloosa, AL 35487-0348, USA
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Eyer JC, Thorn BE. The Learning About My Pain study protocol: Reducing disparities with literacy-adapted psychosocial treatments for chronic pain, a comparative behavioral trial. J Health Psychol 2015; 21:2063-74. [PMID: 25712491 DOI: 10.1177/1359105315570985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic pain is a critical public health problem that affects over 100 million Americans. Medical pain treatments carry undesirable side effects, whereas low-risk psychosocial treatments offer notable benefits, in combination or in isolation. This report presents the protocol for the Learning About My Pain study, one of the first comparative-effectiveness trials funded by the Patient-Centered Outcomes Research Institute. Adhering to published standards for clinical trials (e.g. Standard Protocol Items: Recommendations for Intervention Trials), it provides an overview of the trial (n = 294), comparing cognitive-behavioral and education pain interventions to usual care, and a detailed description of how its methodology reduces the risks from bias.
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Burns JW, Day MA, Thorn BE. Is reduction in pain catastrophizing a therapeutic mechanism specific to cognitive-behavioral therapy for chronic pain? Transl Behav Med 2012; 2:22-9. [PMID: 24073095 PMCID: PMC3717814 DOI: 10.1007/s13142-011-0086-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Mechanisms underlying favorable outcomes of psychosocial interventions for chronic pain are unclear. Theory suggests changes in maladaptive cognitions represent therapeutic mechanisms specific to cognitive-behavioral therapy (CBT). We illustrate the importance of examining whether treatments work either uniquely via mechanisms specified by theory or via mechanisms common to different treatments. Secondary data analysis was conducted to examine the effects of reduction in pain catastrophizing on outcomes following CBT and Pain Education. Generally, reductions in pain catastrophizing were significantly related to outcome improvements irrespective of CBT or Pain Education condition. Results underscore the need to assess whether mechanisms presumed to operate specifically in one treatment do indeed predict outcomes and illustrate the importance of broadening the assessment of mechanisms beyond those specified by theory. Theory-specific, competing, and common mechanisms must all be assessed to determine why our treatments work.
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Affiliation(s)
- John W Burns
- />Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL USA
| | - Melissa A Day
- />The Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall 505 Hackberry Lane, Tuscaloosa, AL 35487-0348 USA
| | - Beverly E Thorn
- />The Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall 505 Hackberry Lane, Tuscaloosa, AL 35487-0348 USA
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Campbell LC. Addressing literacy as a barrier in delivery and evaluation of cognitive-behavioral therapy for pain management. Pain 2011; 152:2679-2680. [PMID: 21963312 DOI: 10.1016/j.pain.2011.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 08/24/2011] [Accepted: 09/07/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Lisa C Campbell
- East Carolina University, Department of Psychology and Center for Health Disparities Research, 210 Rawl, Greenville, NC 27858, USA
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