ANNUAL OCT. 31-NOV. 2, 2017 MEETING ARLINGTON, VA Simplified Group Education & Cognitive-Behavioral Therapy for Chronic Pain: No Prescription Required Beverly E. Thorn, Ph.D., ABPP Professor Emerita The University of Alabama November 1, 2017 #PCORI2017
ANNUAL MEETING | #PCORI2017 Speaker Name [Note to speaker: Please use only one of the next two Disclosures slides depending on your disclosure information. ] Rela latio ionship ip Company ny(ies es) Speakers Bureau Advisory Committee Consultancy Review Panel Board Membership Honorarium Ownership Interests November 8, 2017 2
ANNUAL MEETING | #PCORI2017 Speaker Name • Has nothing to disclose. Organizati tion L Logo go Here re (150 dpi resolution jpg or png file) November 8, 2017 3
ANNUAL MEETING | #PCORI2017 What is Chronic Pain? • Pain lasting more than 3-6 months • Pain that has persisted beyond the time of healing. • Pain without apparent biological value • Non-malignant pain (excludes cancer pain) November 8, 2017 4
ANNUAL MEETING | #PCORI2017 Chronic Pain Impacts Well-Being and Function November 8, 2017 5
ANNUAL MEETING | #PCORI2017 Recent Shifts in Treatment Guidelines for Pain Management • Recognize opioid epidemic • Discourage medication as first-line treatment • Encourage pain self-management training • Include patient education about chronic pain • Include cognitive-behavioral therapy November 8, 2017 6
ANNUAL MEETING | #PCORI2017 Study Objectives • Can we simplify pain self-management treatments, and are they effective? • Do simplified group treatments for pain (Pain Education, Cognitive-Behavioral Therapy) reduce self- reported pain i n intens ensity and inter erference i e in n ph physi sical functioni ning ng over and above that provided by usual medical care, and are these effects maintained at 6- months follow-up? • Is Cognitive-Behavioral Therapy more effective than Pain Education (especially for reducing depr depressi ssion)? November 8, 2017 7
ANNUAL MEETING | #PCORI2017 What is Pain Education (EDU)? • Comes in many forms, but in this study: • Group treatment – 6-8 people, 10 weekly 90-min. session • Based on biop iopsychosocia ial model el (acknowledges biological, but emphasizes psychological and social influences) • Focused on: • Information regarding pain – emphasized how the brain processes pain • Information on pain self-management • Interactive discussion forum • Did not provide skills training November 8, 2017 8
ANNUAL MEETING | #PCORI2017 What is Cognitive-Behavioral Therapy (CBT)? • Comes in many forms, but in this study: • Group treatment – 6-8 people, 10 weekly 90-min sessions • Based on biop iopsychosocia ial model el (acknowledges biological, but emphasizes psychological and social influences) • Focused on: • Self-management skills training • Stress reduction skills (e.g., relaxation) • Thoughts management skills • Emotion management skills • Activity pacing skills November 8, 2017 9
ANNUAL MEETING | #PCORI2017 But…..These Treatments Can Be Difficult To Grasp • Requires the patient to read and write • Requires homework and worksheets • Requires some level of abstract thinking • May require above average cognitive functioning • Sometimes limited to high-functioning individuals November 8, 2017 10
ANNUAL MEETING | #PCORI2017 Simplifying These Treatments Is Crucial For Disadvantaged Patients • Education • Primary literacy & health literacy • Minority Status • Stress of poverty • Underserved November 8, 2017 11
ANNUAL MEETING | #PCORI2017 Did We Simplify Our Treatments? • Simplified patient materials: • Reduced reading level of text • Reduced amount of text • Added illustrations • Increased font size • Increased white space • Reduced cognitive demand of treatment: • Limited the number of concepts per session • Simplified oral presentation of concepts (no jargon) • Collaborative learning via heavy use of flip chart-facilitated discussions • Did not require homework • Gave out weekly CDs with session summaries November 8, 2017 12
ANNUAL MEETING | #PCORI2017 Illustrations Enhanced the Meaning of the Text… November 8, 2017 13
ANNUAL MEETING | #PCORI2017 Reducing Disparities with Literacy- Adapted Psychosocial Treatments for Chronic Pain: A Comparative Trial PCORI Contract #941 • 5/15/13-7/31/17 November 8, 2017 14
ANNUAL MEETING | #PCORI2017 Comparative Effectiveness Trial • 3 Conditions: • Cognitive-Behavioral Therapy (n=95) • Pain Education (n=97) • Medical Treatment as Usual (n=98) • 83% retained at primary endpoint (post-tx) • CBT (87%) • EDU (84%) • TAU (80%) • 75% retained at 6 mo. follow-up November 8, 2017 15
Baseline Characteristics of Study Participants by Treatment Group No. (%) All (n=290) TAU (n=98) CBT (n=95) EDU (n=97) Age, mean (SD) 50.6 (8.9) 49.7 (8.7) 52.2 (8.5) 49.9 (9.2) Women 205 (70.7) 69 (70.4) 67 (70.5) 69 (71.1) Race White/Caucasian 96 (33.1) 38 (38.8) 20 (21.1) 38 (39.2) Black/African-American 194 (66.9) 60 (61.2) 75 (78.9) 59 (60.8) Marital Status Single 71 (24.5) 27 (27.6) 24 (25.3) 20 (20.6) Married or in a 100 (34.5) 36 (36.7) 27 (28.4) 37 (38.1) relationship for > 2 yrs Divorced, Separated, 119 (41.0) 35 (35.7) 44 (46.3) 40 (41.2) Widowed Poverty Status Below poverty status 210 (72.4) 74 (75.5) 65 (68.4) 71 (73.2) Above poverty status 70 (24.1) 20 (20.4) 25 (26.3) 25 (25.8)
Does Simplified CBT Work?? Ye Yes • CBT & EDU, pre-post, and at 6 mos. (not TAU) • Moderate Effect sizes • CBT may have a small advantage: • Larger effects sizes • More Clinically Meaningful Improvements (post & 6 mo) • But EDU is a viable alternative for low- resourced clinics
Finding Good Pain Treatment is Hard. If You’re Not White, It’s Even Harder (NYT, August, 2016) • Ms. Lewis, the former dollar store employee, said the best balm for her pain had been 10 weeks of group cognitive behavioral therapy, which aims to help people change how they think about pain. • “I learned so much I was actually shocked,” Ms. Lewis said of her cognitive behavioral therapy. • “It’s a about t triggering y g your brain t to g o go o to som o something else, o other t than t the p pain.” https://www.nytimes.com/2016/08/10/us/how-race-plays-a-role-in- patients-pain-treatment.html?_r=0
ANNUAL MEETING | #PCORI2017 Learn More • www.pcori.org • info@pcori.org • #PCORI2017 • Pmt.ua.edu November 8, 2017 19
ANNUAL MEETING | #PCORI2017 Questions? November 8, 2017 20
ANNUAL MEETING | #PCORI2017 Thank You! Beverly E Thorn, Ph.D., ABPP Professor Emerita, The University of Alabama 11/1/2017 November 8, 2017 21
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