Simplified Group Education & Cognitive-Behavioral Therapy for - - PowerPoint PPT Presentation

ANNUAL MEETING

• OCT. 31-NOV. 2, 2017

ARLINGTON, VA

#PCORI2017

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

ANNUAL MEETING | #PCORI2017

Speaker Name

Disclosures

Rela latio ionship ip Company ny(ies es) Speakers Bureau Advisory Committee Consultancy Review Panel Board Membership Honorarium Ownership Interests [Note to speaker: Please use only one of the next two slides depending on your disclosure information. ]

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Speaker Name

• Has nothing to disclose.

Organizati tion L Logo go Here re (150 dpi resolution jpg

• r png file)

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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)

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Chronic Pain Impacts Well-Being and Function

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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

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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)?

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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

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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

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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

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Simplifying These Treatments Is Crucial For Disadvantaged Patients

• Education
• Primary literacy & health literacy
• Minority Status
• Stress of poverty
• Underserved

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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

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Illustrations Enhanced the Meaning

• f the Text…

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Reducing Disparities with Literacy- Adapted Psychosocial Treatments for Chronic Pain: A Comparative Trial

PCORI Contract #941

• 5/15/13-7/31/17

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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

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 relationship for > 2 yrs 100 (34.5) 36 (36.7) 27 (28.4) 37 (38.1) Divorced, Separated, Widowed 119 (41.0) 35 (35.7) 44 (46.3) 40 (41.2) 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

• go
• to som
• something

else, o

• ther 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

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Learn More

• www.pcori.org
• info@pcori.org
• #PCORI2017
• Pmt.ua.edu

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Questions?

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Thank You!

Beverly E Thorn, Ph.D., ABPP Professor Emerita, The University of Alabama 11/1/2017