Project Summary
Chronic pain is a significant public health problem that affects more than 116 million Americans; costs $600 billion annually; and is unequally borne by people in low-income brackets, especially ethnic minorities. Many individuals also have health literacy deficits (difficulty understanding their illness and difficulty navigating the healthcare system for treatment), putting them at a greater disadvantage in the healthcare system. Treatment usually relies on expensive medical interventions with negative side effects. Psychosocial treatments, such as Pain Education and Cognitive-Behavioral Therapy (CBT), show promise, but are usually unavailable. Clinicians are poorly equipped to provide psychosocial treatments to patients with low health literacy. Cognitive-behavioral therapies have not been adapted and supported for use in individuals with low health literacy, and even educational materials are often poorly adapted for their needs. To address this problem, the applicant recently completed a small trial showing initial effectiveness of health literacy–adapted pain education and CBT groups for chronic pain in a population with low income and low health literacy. Patients in both treatments reported lower pain by the end of treatment, and the effects were maintained at one year. Patients in the CBT group also reported fewer symptoms of depression after treatment. The current study uses a larger number of participants and directly compares these psychosocial treatments to medical treatment as usual, with the goal of supporting their widespread use in community settings.
Our research questions are:
- In people with chronic pain and low income and/or low education, does participating in a health literacy–adapted psychosocial treatment group improve their pain, and interference in daily activities due to pain, by the end of treatment when compared with a group receiving typical medical care, and are these effects maintained six months later?
- Does participation in the CBT pain management group improve symptoms of depression better than a pain education group by the end of treatment, and are these effects maintained six months later?
Building on an ongoing partnership with a federally qualified health consortium that serves the highly disadvantaged Black Belt region of West Alabama, we will enroll 294 patients with chronic pain. The most important outcomes will be patient-reported pain intensity, interference in daily activities due to pain, depression, and self-reported impressions of overall improvement after treatment. We will use accepted statistical analyses to examine our findings. Based on our earlier study, we expect that our participants will be ~75% female, ~70% African American, and financially disadvantaged, with 60% scoring in the bottom 15% nationally on word reading and 90% at or below the poverty threshold.
Newman AK, Van Dyke BP, Torres CA, et al., The relationship of sociodemographic and psychological variables to chronic pain variables in a low-income population. Pain (May 2017).
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, Journal of Health Psychiatry (February 2015).
Enlisting the Brain in the Fight against Pain - A narrative on how psychosocial treatments and patient education may help some patients with chronic pain.
VIDEO: Research Gaps in Chronic Pain
Beverly Thorn and Toya Burton talks about some of the challenges of managing symptoms of those suffering from chronic pain.
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