Cognitive Behavioral Pain Management Research Articles

Awareness, Beliefs and Practice of Cognitive Behavioral Therapy (CBT) Strategies for Chronic Pain Management Among Physiotherapists

Purpose: To evaluate the awareness, practice and beliefs about CBT strategies for chronic pain management among Physiotherapists. Relevance: Chronic pain can be defined as pain that persists for 3 months or longer and, while not necessarily maladaptive, often leads to physical decline, limited functional ability and emotional distress. CBT has been increasingly used as an effective tool by psychologists in the management of chronic pain that is delivered through individual or group counselling sessions. Cognitive restructuring, relaxation techniques, activity pacing and good sleep hygiene are a few strategies of cognitive behavioral pain management therapies. There is also increasing evidence that supports the use of CBT strategies by Physiotherapists during their treatment for obtaining a positive outcome for chronic pain patients. Method and Analysis: A Google Form was formulated with relevant questions about awareness, practice and beliefs about CBT strategies for chronic pain. The questionnaire was face validated by 3 independent psychologists who practice CBT for chronic pain in their regular practice. This form was then distributed through various Physiotherapy groups in Bangalore via snowball sampling method. The data obtained from the responses were then complied, decoded and quantitatively analysed through content analysis using the SPSS-22. Result: The result showed strikingly contrasting responses from the Physiotherapists, as even though the majority of them were aware of CBT (34.1%), they applied it relatively less (15.3%). Of 63.5% Physiotherapists believed that pain perception is affected by automatic thoughts, while 52.9% agreed that negative thoughts need to be changed into positive coping thoughts. Around 49.4% of Physiotherapists believe in teaching relaxation techniques to their patients with chronic pain. Activity pacing and good sleep hygiene are important, as believed by 25.9% and 47.1% respectively. Physiotherapists (56.5%) accepted that patient needs to be mindful while exercising. Conclusion: Majority of Physiotherapists are aware and have positive beliefs about CBT strategies for chronic pain management. However, comparatively, we can see variations in the application of CBT strategies in their treatment plan. KEY WORDS: Cognitive Behavioral Therapy, chronic pain, Physiotherapy.

Role of self-efficacy for pain management and pain catastrophizing in the relationship between pain severity and depressive symptoms in women with breast cancer and pain

Purpose This study evaluated the relationship between pain and depressive symptoms through pain self-efficacy and pain catastrophizing in breast cancer patients with pain. Design Secondary analysis of a randomized trial investigating a cognitive-behavioral pain management protocol. Sample Females (N = 327) with stage I–III breast cancer and report of at least moderate pain. Methods Pain severity, pain self-efficacy, pain catastrophizing, and depressive symptoms were measured. The proposed model was assessed using structural equation modeling. Results Higher pain severity was significantly related to lower pain self-efficacy and higher pain catastrophizing. Lower pain self-efficacy and higher pain catastrophizing were significantly related to more depressive symptoms. Higher pain severity was significantly associated with more depressive symptoms through lower pain self-efficacy and higher pain catastrophizing. The association between pain severity and depressive symptoms was not significant when specified as a direct effect. Conclusion Pain severity related to depressive symptoms in breast cancer patients via pain self-efficacy and pain catastrophizing. Implications for psychosocial providers Measurement of pain self-efficacy and pain catastrophizing should be incorporated into comprehensive pain assessments for women with breast cancer, as these variables may be relevant therapeutic targets. Psychosocial symptom management interventions should include strategies that increase pain self-efficacy and decrease pain catastrophizing because these pain-related cognitive variables appear to drive the relationship between pain severity and depressive symptoms.

Essential components of care in a multidisciplinary headache center: Perspectives from headache neurology specialists.

Comprehensive headache care involves numerous specialties and components that have not been well documented or standardized. This study aimed to elicit best practices and characterize important elements of care to be provided in multidisciplinary headache centers. Qualitative, semi-structured telephone interviews with a purposive sample of headache neurology specialists from across the US, using open-ended questions. Interviews were recorded, transcribed, and coded. Coded data were further analyzed using immersion/crystallization techniques for final interpretation. Mean years providing headache care was 17.7 (SD=10.6). Twelve of the 13 participants held United Council for Neurologic Subspecialties headache certification. Six described their practice site as providing multidisciplinary headache care. Participants explained most of their patients had seen multiple doctors over many years, and had tried numerous unsuccessful treatments. They noted patients with chronic headache frequently present with comorbidities and become stigmatized. All participants asserted successful care depends on taking time to talk with and listen to patients, gain understanding, and earn trust. All participants believed multidisciplinary care is essential within a comprehensive headache center, along with staffing enough headache specialists, implementing detailed headache intake and follow-up protocols, and providing the newest medications, neuromodulation devices, botulinum toxin injections, monoclonal antibodies, nerve blocks and infusions, and treatment from a health psychologist. Other essential services for a headache center are other behavioral health practitioners providing cognitive behavioral therapy, mindfulness, biofeedback and pain management; and autonomic neurology, neuropsychology, vestibular audiology, sleep medicine, physical therapy, occupational therapy, exercise physiology, speech therapy, nutrition, complementary integrative health modalities, and highly trained support staff. While headache neurology specialists form the backbone of headache care, experts interviewed for this study maintained their specialty is just one of many types of care needed to adequately treat patients with chronic headache, and this is best provided in a comprehensive, multidisciplinary center.

Impaired Health-Related Quality of Life in Brazilian Children with Chronic Abdominal Pain: A Cross-Sectional Study.

We compared the health-related quality of life (HRQOL) of children and adolescents with functional abdominal pain disorders (FAPDs) and organic abdominal pain disorders (ORGDs). This was a single-center, cross-sectional, observational study. The PedsQL 4.0 generic cores scales parent proxy-report was administered to parents/caregivers of 130 and 56 pediatric patients with FAPDs and ORGDs respectively on their first visit. The self-reported pain intensity in the patients was assessed using a visual analog scale (VAS) and facial affective scale (FAS). Irritable bowel syndrome was the most prevalent FAPDs, and the most prevalent ORGDs were reflux esophagitis (41.1%) and gastritis associated with Helicobacter pylori (21.4%). There was no difference in HRQOL among patients diagnosed with ORGDs and FAPDs (p>0.05). Patients with ORGDs and FAPDs had lower HRQOL Scale scores than healthy Brazilian and American children's references, with a high proportion of children at risk for impaired HRQOL (p<0.0001). There was no difference in the VAS and the FAS scores between the ORGDs and the FAPDs. FAPDs had a higher prevalence of girls' and couples' disagreement (p<0.02), although poor school performance (p<0.0007) and bullying (p<0.01) were higher in patients with ORGD. This study revealed that there was a difference in impaired HRQOL between patients with ORGDs and FAPDs. Thus, considering the high prevalence of chronic abdominal pain in children, a well-founded treatment plan is necessary for a multidisciplinary cognitive-behavioral Pain management program.

Five-year observational study of Internet-delivered cognitive behavioural pain management when offered as routine care by an online therapy clinic.

BackgroundInternet‐delivered cognitive behavioural pain management programmes (PMPs) are effective, but less is known about their use outside of research trials. Five years of data from offering the Internet‐delivered cognitive behavioural PMP in an online therapy clinic was examined to assess effectiveness, acceptability and predictors of outcomes.MethodsPatients (N = 293) were offered a previously validated 8‐week Internet‐delivered cognitive behavioural PMP and administered measures at pre‐treatment, post‐treatment and 3 months.ResultsThere was growth in demand for an Internet‐delivered cognitive behavioural PMP over time (n = 64 first year to n = 133 fifth year). Moderate‐to‐large improvements on depression (post‐treatment 35% reduction; 3‐month 41% reduction) and anxiety (post‐treatment 37% reduction; 3‐month 41% reduction), and small‐to‐moderate improvements on disability (post‐treatment 19% reduction; 3‐month 20% reduction) were found. Lesson completion and satisfaction were high. Lower pain acceptance, lower pain self‐efficacy and higher pain intensity were associated with lower improvements on depression, anxiety and disability.ConclusionsThis longitudinal observational study provides support for Internet‐delivered cognitive behavioural PMPs when offered as routine care by an online therapy clinic.SignificanceThis 5‐year observational study provides support for Internet‐delivered cognitive behavioural pain management programs (PMPs) offered as routine care in an online therapy clinic. Interest in the service grew over 5 years. Outcomes, engagement and satisfaction were strong. Higher pain acceptance, pain self‐efficacy and lower pain severity were associated with greater post‐treatment improvements on depression, anxiety and disability.

Acceptability of psychologically-based pain management and online delivery for people living with HIV and chronic neuropathic pain: a qualitative study.

Chronic neuropathic pain is common in people living with HIV. Psychological treatments can improve quality of life for people with chronic pain in general, and online delivery can increase access to these treatments. However, the acceptability of psychological treatment and online delivery have not been investigated in-depth in people living with HIV and chronic neuropathic pain. Therefore, a qualitative study was undertaken to explore views about a psychological treatment for pain management in this population and to investigate the acceptability of online treatment delivery. Qualitative interviews were conducted and analysed using inductive thematic analysis, adopting a critical realist perspective. Twenty-six people living with HIV and chronic neuropathic pain completed semi-structured interviews. Their views about a psychological treatment for pain management and online delivery were explored in-depth. Three themes and 12 subthemes were identified. Theme one represents a desire for a broader approach to pain management, including not wanting to take more pills and having multidimensional goals that were not just focussed on pain relief. Theme two includes barriers to online psychologically-based pain management, including concerns about using the Internet and confidentiality. Theme three describes treatment facilitators, including accessibility, therapist support, social connection, and experiencing success. A psychological treatment for chronic neuropathic pain management appears acceptable for people living with HIV. Therapist-supported online delivery of cognitive-behavioural pain management may be acceptable for people living with HIV given appropriate development of the treatment to address identified barriers to engagement. These data can inform developments to enhance engagement in online psychologically-informed pain management in people living with HIV and more broadly in remote delivery of psychological treatments.

Effects of a pain management programme on occupational performance are influenced by gains in self-efficacy

Introduction The perceived capacity to perform particular activities or skills (i.e. self-efficacy) is paramount in occupational therapy and is thought to be reinforced by actual functional capacity. This study examined whether changes in self-efficacy or confidence to lift weighted items influences changes in occupational performance and disability levels in patients attending a cognitive behavioural therapy pain management programme. Method Clients attending an 8-week cognitive behavioural therapy pain management programme ( N = 125) completed questionnaires before treatment, at discharge, and at 3-month and 6-month reviews, including measures of pain self-efficacy, disability and self-perceived performance and satisfaction using the Canadian occupational performance measure. Analyses examined disability and occupational performance over time, adjusting for baseline characteristics (age, sex, education), and sought to determine whether self-efficacy or lifting confidence influenced the outcomes. Results The level of disability, lifting confidence, self-efficacy and occupational performance all improved over time; however, only occupational performance and lifting confidence maintained improvements up to the 6-month review. Self-efficacy had a greater impact on occupational performance than lifting confidence.

Web-based cognitive-behavioral intervention for pain in pediatric acute recurrent and chronic pancreatitis: Protocol of a multicenter randomized controlled trial from the study of chronic pancreatitis, diabetes and pancreatic cancer (CPDPC)

IntroductionAbdominal pain is common and is associated with high disease burden and health care costs in pediatric acute recurrent and chronic pancreatitis (ARP/CP). Despite the strong central component of pain in ARP/CP and the efficacy of psychological therapies for other centralized pain syndromes, no studies have evaluated psychological pain interventions in children with ARP/CP. The current trial seeks to 1) evaluate the efficacy of a psychological pain intervention for pediatric ARP/CP, and 2) examine baseline patient-specific genetic, clinical, and psychosocial characteristics that may predict or moderate treatment response. MethodsThis single-blinded randomized placebo-controlled multicenter trial aims to enroll 260 youth (ages 10–18) with ARP/CP and their parents from twenty-one INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In search for a cuRE) centers. Participants will be randomly assigned to either a web-based cognitive behavioral pain management intervention (Web-based Management of Adolescent Pain Chronic Pancreatitis; WebMAP; N = 130) or to a web-based pain education program (WebED; N = 130). Assessments will be completed at baseline (T1), immediately after completion of the intervention (T2) and at 6 months post-intervention (T3). The primary study outcome is abdominal pain severity. Secondary outcomes include pain-related disability, pain interference, health-related quality of life, emotional distress, impact of pain, opioid use, and healthcare utilization. ConclusionsThis is the first clinical trial to evaluate the efficacy of a psychological pain intervention for children with CP for reduction of abdominal pain and improvement of health-related quality of life. Findings will inform delivery of web-based pain management and potentially identify patient-specific biological and psychosocial factors associated with favorable response to therapy.Clinical Trial Registration #: NCT03707431.

Long-term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: a concise report of an extended cohort with a minimum of 5-year follow-up

PurposeTreatment options for chronic low back pain (CLBP) include cognitive behavioral interventions. Most of these interventions only have small and short-lived effects. Using strict inclusion criteria for participation in an intensive combined physical and psychological program, encouraging effects were reported at 1-year follow-up. This study evaluates the long-term follow-up results of the same program. The hypothesis is that previously reported results are maintained.MethodsStructured interviews were conducted in a prospective extended cohort with a minimum of 5-year follow-up in a similar fashion as in the 1-year follow-up report. The median follow-up in this cohort was 6.5 years. The extended cohort consisted of 277 patients (85% response).ResultsOutcomes include daily functioning, quality of life, current pain intensity, pain disturbance in daily activities and indicators of the use of pain medication and healthcare services. The previously reported positive 1-year follow-up results were maintained at a minimum of 5-year follow-up. Disability as measured with the Oswestry disability index (ODIv2.1a) decreased from 40 to 27 in the first year. This positive result was maintained at the 6.5-year follow-up with an ODI of 28. Pain intensity (NRS 0–100) improved from 60 to 39 in the first year, and at 6.5 years, this had further improved to 33. Improvement in quality of life (SF 36) at 1-year follow-up was maintained at 6.5-year follow-up, and healthcare consumption had decreased substantially as measured with doctor visits and analgesics used for CLBP.ConclusionSelected and motivated patients with longstanding CLBP improve fast after an intensive combined physical and psychological program in daily functioning, pain and quality of life. Positive 1-year results are maintained, and healthcare utilization was still reduced at a minimum of 5-year follow-up.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

Estimating the Frequency, Severity, and Clustering of SPADE Symptoms in Chronic Painful Chemotherapy-Induced Peripheral Neuropathy

Background: Patients undergoing treatment for cancer commonly experience symptoms such as sleep disturbance, pain, anxiety, depression, and low energy/fatigue (SPADE), subsequently altering physical function and complicating effective symptom management. However, little is known about the frequency, severity, and clustering of SPADE symptoms in individuals with chronic painful chemotherapy-induced peripheral neuropathy (CIPN). Aims/Design: The purpose of this cross-sectional, secondary analysis was to describe the frequency, severity, and clustering of SPADE symptoms and their association with physical function in individuals with chronic painful CIPN. Participants/Subjects: Sixty individuals with chronic painful CIPN were recruited from five academic and community oncology outpatient centers to participate in a randomized controlled pilot trial designed to test the efficacy of a cognitive behavioral therapy-based pain management program. Methods: Participants completed the 0-10 Average CIPN Pain Numerical Rating Scale and Patient-Reported Outcome Measurement Information System measures for sleep-related impairment, anxiety, depression, fatigue, and pain interference via tablet before being randomly assigned to a study arm. The frequency, severity, and clustering of SPADE symptoms were calculated via descriptive statistics and Partitioning Around Medoids cluster analysis. Spearman rank correlation was performed to determine the association between number of SPADE symptoms and pain interference severity. Results and Conclusions: Participants (n = 59) experienced numerous SPADE symptoms. 66.1% of participants experienced at least two SPADE symptoms concurrently. The cluster analysis revealed high (n = 36) and low (n = 23) severity subgroups. There was a moderate correlation (r = 0.48) between the number of SPADE symptoms and pain interference severity. Determining the clustering of SPADE symptoms in individuals with chronic painful CIPN may lead to targeted multifaceted interventions to improve physical function.

Potential mediators of improvement in painful chemotherapy-induced peripheral neuropathy via a web-based cognitive behavioural intervention.

Preliminary evidence suggests that a self-guided cognitive and behaviourally-based pain management intervention (PROSPECT) is effective for chronic painful chemotherapy-induced peripheral neuropathy (CIPN), but its mechanism of action is unknown. The purpose of this secondary analysis was to explore if changes in anxiety, depression, sleep-related impairment, or fatigue mediated improvements in worst pain following PROSPECT in individuals with chronic painful CIPN. Sixty participants were randomized to receive self-guided cognitive behavioural pain management (access for eight weeks) or treatment as usual. A seven-day worst CIPN pain diary and the PROMIS measures of anxiety, depression, fatigue, and sleep-related impairment were administered pre/posttest (eight-weeks). Causal mediation analysis was used to quantify mediators of worst pain improvement. None of the hypothesized mediators had a statistically significant effect on worst pain (n=38). Further research is needed to identify potential mediators of pain intensity that can be targeted by specific cognitive behavioural strategies to improve painful CIPN severity.

A feasibility study to develop and test a Spanish patient and provider intervention for managing osteoarthritis in Hispanic/Latino adults (PRIMO-Latino)

BackgroundArthritis affects approximately 50 million adults in the USA. Hispanics/Latinos have a higher prevalence of arthritis-attributed activity limitations primarily related to osteoarthritis (OA). Hispanic/Latinos are less likely to receive hip replacement independent of health care access, and they are less likely to receive knee replacement. There have been few interventions to improve OA treatment among the Hispanic/Latino population in the USA. In our study, we aimed to develop and test a telephone delivered culturally appropriate Spanish behavioral intervention for the management of OA in Hispanic/Latino adults.MethodsWe conducted a feasibility study in an academic health center and local community in Durham, North Carolina. We enrolled self-identified Spanish speaking overweight/obese adults (≥ 18) with OA of the knee and/or hip under the care of a primary health care provider. The 12-month patient intervention focused on physical activity, weight management, and cognitive behavioral pain management skills. The patient intervention was delivered via telephone with calls scheduled twice per month for the first 6 months, then monthly for the last 6 months (18 sessions). The one-time provider intervention included delivery of patient-specific OA treatment recommendations, based on patients’ baseline data and published guidelines. The primary measures were metrics of feasibility, including recruitment and intervention delivery. We also assessed pain, stiffness, and function using the Spanish-Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).ResultsA total of 1879 participants were identified for potential enrollment. Of those, 1864 did not meet inclusion criteria, were not able to be reached or refused. Fifteen participants enrolled in the intervention. The mean number of phone calls completed was 14.7. Eighty percent completed more than 16 calls. The mean WOMAC baseline score (SD) was 39 (20); mean improvement in WOMAC scores between baseline and 12 months, among 11 participants who completed the study, was − 13.27 [95% CI, − 25.09 to − 1.46] points.ConclusionRecruitment of Hispanics/Latinos, continues to be a major challenge. A Spanish-based telephone delivering lifestyle intervention for OA management in Hispanic/Latino adults is feasible to deliver and may lead to improved OA symptoms. Future research is needed to further test the feasibility and effectiveness of this type of intervention in this segment of the population.Trial registrationNCT01782417

Cognitive Mediators of Change in Physical Functioning in Response to a Multifaceted Intervention for Managing Osteoarthritis

Although non-pharmacological interventions have been shown to improve physical functioning in individuals with osteoarthritis (OA), the mechanisms by which this occurs are often unclear. This study assessed whether changes in arthritis self-efficacy, perceived pain control, and pain catastrophizing mediated changes in physical functioning following an osteoarthritis intervention involving weight management, physical activity, and cognitive-behavioral pain management. Three hundred Veteran patients of 30 primary care providers with knee and/or hip OA were cluster randomized to an OA intervention group or usual care. The OA intervention included a 12-month phone-based patient behavioral protocol (weight management, physical activity, and cognitive-behavioral pain management) plus patient-specific OA treatment recommendations delivered to primary care providers. Using linear mixed models adjusted for provider clustering, we observed that baseline to 6-month changes in arthritis self-efficacy and pain control partially mediated baseline to 12-month physical functioning improvements for the intervention group; catastrophizing did not. Findings of a mediating role of arthritis self-efficacy and pain control in intervention-related functional changes are consistent with hypotheses and align with theoretical assertions of the role of cognitions in cognitive and behavioral interventions for chronic pain. However, contrary to hypotheses, catastrophizing was not found to be a mediator of these changes.

Effectiveness, acceptability and feasibility of an Internet-delivered cognitive behavioral pain management program in a routine online therapy clinic in Canada

ABSTRACT Background Access to face-to-face cognitive behavioral pain management programs is very limited. Internet-delivered cognitive behavioral pain management has potential to improve client access to care but is not readily available in Canada. Aims The present study explored the effectiveness, acceptability, and feasibility of a previously validated Internet-delivered cognitive behavioral pain management course, the Pain Course, when offered in a publicly funded provincial Online Therapy Clinic. The five-lesson course was delivered over 8 weeks and was accompanied by brief weekly contact from a coach via weekly telephone calls and secure online messages. Methods A single-group open trial design (ISRCTN15509834) was employed (n = 55). Effectiveness was assessed by examining symptom measures at pretreatment, posttreatment, and 3-month follow-up. Completion rates and satisfaction ratings were used to examine acceptability. Feasibility was assessed by examining time required for service delivery. Results Results were highly comparable to past studies of the Pain Course showing improvements on primary measures of disability (Cohen’s d = 0.45; 18% reduction), depression (Cohen’s d = 0.85; 36% reduction), and anxiety (Cohen’s d = 0.52; 32% reduction) at posttreatment that were maintained at follow-up. Completion rates (76%) and course satisfaction ratings (85% would recommend course) were high. Coach time per week was estimated as M = 12.67 (SD = 6.53) min. Conclusions The findings add to existing literature on the Pain Course demonstrating for the first time the effectiveness, acceptability, and feasibility of Internet-delivered cognitive behavioral pain management programs for adults with chronic pain in a routine online therapy clinic.

Self-Guided Online Cognitive Behavioral Strategies for Chemotherapy-Induced Peripheral Neuropathy: A Multicenter, Pilot, Randomized, Wait-List Controlled Trial

The purpose of this pilot, parallel, randomized controlled trial was to examine the efficacy of a self-guided online cognitive and behaviorally-based pain management intervention (Proactive Self-Management Program for Effects of Cancer Treatment [PROSPECT]) to reduce “worst” pain for individuals with chronic painful chemotherapy-induced peripheral neuropathy (CIPN). Secondary outcomes included “average” pain, nonpainful CIPN symptom severity, impression of change, and pain interference. Sixty patients with chronic painful CIPN were recruited from 5 outpatient academic and community cancer centers. Patients were randomized in a 1:1 ratio to receive either 8 weeks of PROSPECT or usual care. A 7-day electronic “worst” pain intensity diary and standardized measures of pain interference, nonpainful CIPN symptom severity, impression of change, and “average” pain were administered pre/post intervention. Postintervention mean scores were evaluated between groups using analysis of covariance adjusting for baseline. Individuals who received the PROSPECT intervention (n = 19) had significantly greater improvements in “worst pain” compared with individuals receiving usual care (n = 19; P = .046, d = .58). There were no significant differences in mean scores between groups for the secondary outcomes (n = 42). A larger, adequately powered study testing the PROSPECT intervention is needed to determine if improvements in pain may be sustained, evaluate the effect of the intervention on the secondary outcomes, and identify mediators of pain intensity-related improvement. PerspectiveThis study explores the efficacy of an 8-week online cognitive behavioral pain management intervention for chronic painful CIPN. Intervention use resulted in greater improvements in “worst” pain than usual care alone. The findings provide preliminary support for the efficacy of a nonpharmacological intervention for chronic painful CIPN.

Neuropathic pain in a rehabilitation setting after spinal cord injury: an interpretative phenomenological analysis of inpatients' experiences.

Qualitative, semi-structured interviews. Neuropathic pain (NP) can be psychologically and physically debilitating, and is present in approximately half of the spinal cord injured (SCI) population. However, under half of those with NP are adherent to pain medication. Understanding the impact of NP during rehabilitation is required to reduce long-term impact and to promote adherence to medication and psychoeducation recommendations. United Kingdom. Five males and three females with SCI and chronic NP, resident in rehabilitation wards at a specialist SCI center in the United Kingdom, took part. Semi-structured interviews were conducted with participants less than 15 months post-SCI (mean = 8.4 months). Verbatim transcripts were subject to interpretative phenomenological analysis (IPA). Three super-ordinate themes were identified, mediating pain and adherence: (1) the dichotomy of safety perceptions; (2) adherence despite adversity; and (3) fighting the future. Analyses suggest that experience of the rehabilitation setting and responsiveness of care shapes early distress. Attitudes to medication and psychosocial adjustment are relevant to developing expectations about pain management. Enhancing self-efficacy, feelings of safety in hospital, and encouraging the adoption of adaptive coping strategies may enhance psychosocial and pain-related outcomes, and improve adherence to medication. Encouraging adaptive responses to, and interpretation of, pain, through the use of interventions such as coping effectiveness training, targeted cognitive behavioral pain management, and acceptance-based interventions such as mindfulness, is recommended in order to reduce long-term reliance on medication.

A Cognitive Behavioural Therapy Pain Management Programme for Neuropathic Pain Post Spinal Cord Injury: A Feasibility Study Including the Clinician and Patient Perspectives

A Cognitive Behavioural Therapy Pain Management Programme for Neuropathic Pain Post Spinal Cord Injury: A Feasibility Study Including the Clinician and Patient Perspectives

Quality and Usability of Arthritic Pain Self-Management Apps for Older Adults: A Systematic Review.

To appraise the quality and usability of currently available pain applications that could be used by community-dwelling older adults to self-manage their arthritic pain. A systematic review. Searches were conducted in App Store and Google Play to identify pain self-management apps relevant to arthritic pain management. English language pain management apps providing pain assessment and documentation function and pain management education were considered for inclusion. A quality evaluation audit tool based on the Stanford Arthritis Self-Management Program was developed a priori to evaluate app content quality. The usability of included apps was assessed using an established usability evaluation tool. Out of the 373 apps that were identified, four met the inclusion criteria. The included apps all included a pain assessment and documentation function and instructions on medication use, communication with health professionals, cognitive behavioral therapy-based pain management, and physical exercise. Management of mood, depression, anxiety, and sleep were featured in most apps (N = 3). Three-quarters (N = 3) of the apps fell below the acceptable moderate usability score (≥3), while one app obtained a moderate score (3.2). Few of the currently available pain apps offer a comprehensive pain self-management approach incorporating evidence-based strategies in accordance with the Stanford Arthritis Self-Management Program. The moderate-level usability across the included apps indicates a need to consider the usability needs of the older population in future pain self-management app development endeavors.

Self-guided online cognitive behavioral strategies for chemotherapy-induced peripheral neuropathy (CIPN): A multicenter, single blind, randomized, wait-list controlled trial.

e21710 Background: Four in 10 individuals receiving neurotoxic chemotherapy develop chronic painful CIPN, symptoms which negatively influence quality of life and physical function, and may require the withdrawal of effective chemotherapy. However, few recommended pharmacological and no effective non-pharmacological treatments for chronic painful CIPN exist. The purpose of the study was to examine the efficacy of an online cognitive behavioral pain management intervention, the PROactive Self-Management Program for Effects of Cancer Treatment ( PROSPECT), to reduce worst pain intensity in individuals with chronic painful CIPN. The secondary outcomes were average pain intensity, non-painful CIPN symptoms, and impaired function. Methods: Sixty patients with chronic painful CIPN were randomized (1:1 ratio) to receive either 8 weeks of PROSPECT or usual care. A 7-day electronic worst CIPN pain intensity diary was completed at the baseline and eight week time points. At the same time points, participants completed electronic standardized measures of functional impairment, non-painful CIPN symptom severity, and average CIPN pain intensity. Mean change scores from baseline and eight week surveys were compared between groups using ANCOVA adjusting for baseline. Results: Individuals who received the PROSPECT intervention had a mean change in worst pain intensity of -0.94 ( SD = 1.36, Range = -3.29 – 1.29). Those in the control group had a mean change score of 0 ( SD = 1.31, Range = -3.43 – 2.86) ( p = 0.046; d = 0.53) ( n = 38). For the secondary outcomes, no significant mean change score differences were found between groups. Conclusions: PROSPECT use significantly improved worst pain intensity, but not secondary outcomes, in individuals with chronic painful CIPN. A larger study testing PROSPECT is needed to determine if improvements in worst pain intensity may be sustained, to evaluate the effect of the intervention on the secondary outcomes, and to identify mediators of pain-related improvement. If shown to be efficacious with further testing, PROSPECT may be added to pharmacological modalities for the treatment of chronic painful CIPN. Clinical trial information: NCT02760654.

Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care

A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes. Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109). 10 Duke University Health System community-based primary care clinics. 537 outpatients with symptomatic hip or knee osteoarthritis. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups. No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P= 0.40), provider (2.5 [CI, -0.9 to 5.9]; P= 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P= 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. The study involved 1 health care network. Data on provider referrals were not collected. Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care. National Institute of Arthritis and Musculoskeletal and Skin Diseases.