(532) Initial feasibility reports of a novel cognitive behavioral therapy (CBT) pain self-management treatment modality

Abstract

s The Journal of Pain S109 (532) Initial feasibility reports of a novel cognitive behavioral therapy (CBT) pain self-management treatment modality C Egan, D Higgins, K LaChappelle, R Czlapinski, J Kirlin, K Spreyer, D Cervone, R Kerns, and A Heapy; VA Connecticut Healthcare System, West Haven, CT In light of the high prevalence of chronic pain in the US, a recent Institute of Medicine report recommended the promotion and wider availability of pain self-management interventions. However, many patients experience barriers to accessing in-person treatment due to travel and schedule limitations. Interactive voice response (IVR) is a computerized telephone-based technology that allows patients to receive pre-recorded information and answer automated questions, thereby facilitating at-home treatment. The Co-Operative Pain Education Self-management (COPES) study is a randomized non-inferiority trial of IVR-delivered CBT for chronic low back pain versus standard face to face (F2F) CBT. IVR treatment consisted of a patient workbook supplemented by 10 weeks of daily IVR calls that provided pre-recorded didactic information and weekly, pre-recorded personalized therapist feedback. F2F treatment consisted of ten weekly, 30-minute treatment sessions. Both conditions included daily IVR calls to collect pain-related symptoms, adherence to pain coping skill practice and pedometer-measured step counts. We examined the feasibility of IVR-delivered treatment in the domains of treatment retention, IVR call completion, skill practice adherence, and treatment satisfaction. The sample included the first 34 participants entered into the trial (IVR: n=15, F2F: n=19). Mean age was 58.6 (SD=11.13); 83% were male; 56.5% were White, and mean pain intensity was 6.5 (SD=1.59) on a 0-10 numeric rating scale. Participants in the IVR condition demonstrated high retention rates (IVR 86.67% v. F2F 68.42%), completed the majority of the 77 daily IVR calls (IVR 90.16% v. F2F 83.03) and reported high levels of skill practice adherence (7.61/10 v. F2F 6.64/10). IVR participants indicated satisfaction with treatment length, therapist interaction, and overall treatment at equivalent or higher levels than F2F participants. Preliminary results from this ongoing trial indicate that IVR-delivered CBT for pain self-management is feasible and that participants actively engaged in the intervention despite receiving no direct therapist contact. (533) Control over catastrophizing: development of a singlesession psychobehavioral intervention to reduce pain catastrophizing B Darnall, J Sturgeon, M Kao, and S Mackey; Stanford University, Palo Alto, CA Pain catastrophizing is a distressing pattern of rumination, magnification, and feelings of helpless about pain that negatively impacts pain intensity and treatment response. Catastrophizing is often treated across multiple individual psychotherapy visits or within a general pain class that typically spans 6-8 weeks. To reduce patient burden and speed access to low-cost pain care, we developed andpilot tested a single-session, 2-hour CBT-based class solely designed to treat catastrophizing. Content included psychoeducation on pain, catastrophizing and mind-body science. Participants developed a personal plan for daily use of the skills learned (relaxation response, thought stopping, reframing, and self-soothing). The classwas free andno compensationwas offered for completion of follow ups. Fifty-seven mixed etiology chronic pain patients (Women=42; 74%) receiving care in a multidisciplinary pain clinic attended the class. The Pain Catastrophizing Scale (PCS) was administered at class baseline and post-class at 2 and 4weeks via email link. Post-class anonymous acceptability and satisfaction ratings were sufficient (97%). The 48 (84%) participants that completed at least one follow up PCS were included in the analyses. Week 2 PCS was completed by 43 (90%) and 26 (54%) completed week 4 PCS. PCS means were 24.31 (SD=11.09) at baseline, 16.95 (SD=10.71) at week 2 and 13.88 (SD =10.02) at week 4. Within subjects repeated measures ANOVA revealed omnibus changes (F=45.97), and paired T-test contrasts revealed reduced PCS scores at weeks 2 and 4 compared to baseline (both p<.001). Effect sizes were medium (Cohen’s d = 0.68) and large (Cohen’s d = 0.99) for weeks 2 and 4 respectively. Preliminary findings suggest that this brief, focusedCBTclass may reduce catastrophizing about pain. Controlled studies are needed and should include patient characteristics to determine moderator and mediators, and longer latency periods to determine the stability of treatment effects. (534) Exploring suicide risk factors in a veteran chronic pain sample S Miller, M Clark, R Gironda, and J Murphy; James A Haley Veterans Hospital,