Results Summary

What was the research about?

Chronic pain is pain that lasts for months or years. More than 116 million Americans have chronic pain each year. Usual care for chronic pain includes medicine, adjustments to the spine, and physical therapy. Other options that work well include educating patients about chronic pain and teaching skills to manage it. But patients with limited reading skills may find it hard to understand and use these options.

In this study, the research team compared two types of group treatment with usual care alone. The two types of treatment were pain education and cognitive behavioral therapy (CBT). In addition to getting usual care, pain education taught patients about managing chronic pain. CBT taught patients the same information about chronic pain as well as skills for relaxing and managing their pain. The team made the materials for both group treatments easy to use for patients with limited reading skills. This included using large print and drawings and writing at a fifth-grade reading level.

What were the results?

People who got either pain education or CBT along with usual care had less pain than people who had only usual care. They also reported that pain got in the way of doing everyday things less than it did for those who had only usual care. People experienced these improvements slightly more with CBT than with pain education. There were no differences in depression between the groups.

Who was in the study?

The study included 290 patients with chronic pain who got treatment at health clinics in Alabama. Of the people in the study, 71 percent were women, 67 percent were African American, and 33 percent were white. In addition, 68 percent had a high school degree or less and 72 percent had low incomes. People in the study read at between a seventh- and an eighth-grade reading level. The average age was 51.

What did the research team do?

The research team assigned patients to one of three groups by chance. The first group received usual care plus pain education. The second group got usual care plus CBT. Patients in the pain education and CBT groups attended weekly 90-minute group sessions for 10 weeks. The third group received only usual care for chronic pain. The team interviewed all patients before the study, when treatment ended, and again six months after that.

Patients, doctors, and other clinic staff helped the research team design the study and find people to be in the study.

What were the limits of the study?

The study took place in Alabama only. Most of the patients were African-American women with low incomes and a high school degree or less education. The results may be different for other groups of people and people in other locations. Patients had their transportation costs paid for by the study. People may be less likely to come to weekly sessions if the clinic cannot help cover transportation costs.

How can people use the results?

Patients and their doctors may want to use group pain education or group CBT created for patients with limited reading skills to manage patients’ chronic pain. People with limited reading skills can successfully use treatment materials that are easier to read and understand than standard materials.

Final Research Report

View this project's final research report.

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Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also confirms that the research has followed PCORI’s Methodology Standards. During peer review, experts who were not members of the research team read a draft report of the research. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. Reviewers do not have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve how the research team analyzed its results or reported its conclusions. Learn more about PCORI’s peer-review process here.

In response to peer review, Thorn made changes including

  • Adding more details about how the interventions under study were modified for participants with low literacy
  • Providing more information about how stakeholders were involved in modifying intervention content
  • Clarifying how the study defined clinically meaningful change on a measure of depression symptoms
  • Qualifying the results of subgroup analyses by stressing that these results were exploratory and would need future replication
  • Describing exploratory sensitivity analyses of the outcomes only for participants who completed an at least six sessions of the interventions, and comparing those results to their main results

Conflict of Interest Disclosures

Project Information

Beverly E. Thorn, PhD
University of Alabama-Tuscaloosa
Reducing Disparities with Literacy-Adapted Psychosocial Treatments for Chronic Pain: A Comparative Trial

Key Dates

December 2012
April 2018

Study Registration Information


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Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: April 16, 2024