Professional Abstract

Objective

To compare the effectiveness of a pain coping skills training (pain CST) program culturally tailored for African Americans with hip or knee osteoarthritis plus usual care versus usual care alone in reducing pain severity

Study Design

Design Elements	Description
Design	Randomized controlled trial
Population	248 African-American adults with hip or knee osteoarthritis
Interventions/ Comparators	Pain CST program plus usual care Usual care alone
Outcomes	Primary: pain severity Secondary: physical function, pain interference, mental and physical health, pain coping attempts, pain catastrophizing, depressive symptoms, arthritis self-efficacy, physical activity, patient impressions of osteoarthritis symptoms
Timeframe	9-month follow-up for primary outcome

Compared with white Americans, African Americans are more likely to have osteoarthritis and report higher levels of osteoarthritis-related pain. This randomized controlled trial compared the effectiveness of a pain CST program culturally tailored for African Americans with hip or knee osteoarthritis plus usual care versus usual care alone in reducing pain severity. The research team based the program on existing pain CST programs for patients with various chronic pain conditions and then engaged clinicians, public health representatives, and African Americans with osteoarthritis to help make the program culturally appropriate, such as presenting skills in a way that reflected the patients’ cultural and spiritual values.

All patients received their usual care for osteoarthritis throughout the study. The research team randomly assigned patients to receive the pain CST program plus usual osteoarthritis care or usual care alone. The program included 11 weekly, 30–45 minute telephone sessions with a counselor. During sessions, the counselor taught patients cognitive and behavioral pain coping skills, helped patients practice these skills, worked with patients to set goals for applying them, and encouraged problem solving. Patients in the program also received handouts during each session and an audio guide for muscle relaxation. All patients completed follow-up surveys on study outcomes at the start of the program and three and nine months after the program ended.

The study included 248 African Americans with hip or knee osteoarthritis who received care at one of two health systems in North Carolina. The average age was 59, and 51% were male.

Patients, clinicians, and public health and advocacy organization representatives provided feedback throughout the study.

Results

Patients in the pain CST program and those who received usual care alone did not differ in reported reductions in pain severity after three or nine months.

Compared with those who received usual care alone, patients in the pain CST program reported more improvement in arthritis self-efficacy, reduction in pain catastrophizing, increases in pain coping attempts, and improvement in patient impressions of arthritis symptoms (all p<0.01). The groups did not differ in any other secondary outcomes.

Limitations

Patients in the study all lived in one region of North Carolina. Results may differ in other locations. Also, 20% of patients in the pain CST program attended fewer than two sessions, which may have affected the study’s results.

Conclusions and Relevance

Compared with usual care alone, the pain CST program did not improve pain severity among African Americans with hip or knee osteoarthritis. However, the program improved measures of pain coping and perceived ability to manage pain.

Future Research Needs

Future research could continue to explore ways to help African Americans with hip or knee osteoarthritis cope with pain. Researchers could also examine ways to improve intervention adherence.