Treatment of Veterans With Chronic Low Back Pain

NCT ID: NCT00361270

Last Updated: 2018-08-27

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

161 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-10-01

Study Completion Date

2018-06-30

Brief Summary

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The purpose of this study is to assess the effectiveness of hypnosis in the treatment of chronic low back pain.

Detailed Description

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Chronic low back pain (CLBP) is one of the most disabling and common conditions (Loeser, 2001). Eighty percent of men and women will suffer from acute back pain at some point in their lives, with an estimated 10% becoming chronic (King et al., 2001); and the cost of CLBP to society is staggering (Turk, 2002). For example, a nation-wide study of the VHA Health Care System by Yu and colleagues (Yu et al., 2003) reported that 10.6% or 361,868 Veterans who were being cared for by the VA suffered from CLBP, costing the system an estimated $22 million dollars in fiscal year 1999 alone. This figure applies to the cost of medical care only and does not include the cost from the impact of the condition on the Veterans such as disability, lost wages, and other associated medical and psychiatric conditions as well as untold suffering and interference in daily activities.

The efficacy of hypnosis as a treatment for acute and some chronic pain conditions has been well documented. One recent meta-analysis of 18 studies indicated a moderate to large hypno-analgesic effect (Montgomery et. al., 2000). Included in this meta-analysis were studies of a variety of clinical pain syndromes, such as acute/transient pain resulting from burns, radiological procedures, or coronary/ischemic pain, as well as chronic pain due to cancer or headaches. However, none of the studies in this review targeted CLBP. The authors concluded that ".the average participant treated with hypnosis demonstrated greater analgesic response than 75% of participants in standard and no-treatment groups" (page 143). Similarly, Patterson and Jensen (2003) reviewed randomized control trials of hypnosis and clinical pain, and concluded that "Hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions."

The proposed research will (1) conduct a randomized controlled clinical trial to further validate and confirm the findings from a recently completed pilot project showing that hypnosis is efficacious in reducing pain intensity and pain interference and the improving the quality of life of Veterans suffering from CLBP (see preliminary studies section, below), (2) evaluate the relative importance of home practice of hypnosis, (3) determine if the beneficial effects of hypnosis are long lasting, and (4) determine the predictors of treatment outcome, in particular, hypnotizability (a general and stable trait ability to respond to hypnotic suggestions), but also frequency of practice. In this study, a control condition will be used that is credible to patients, but is known to have only minimal effects on pain.

The four treatment groups are: Group 1 - full in-person hypnosis series (8 sessions) without home practice, Group 2 - full in-person hypnosis series (8 sessions) with home practice with CDs, Group 3 - brief in-person hypnosis series (2 sessions) with home practice with CDs, and Group 4 - a minimally effective control condition (minimal biofeedback (8 sessions) designed to appear credible but have minimal effects). Subjects: 160 subjects will be recruited from the MEDVAMC Pain Management Program via posters and the program staff. Inclusion criteria: Chronic low back pain for at least 6 months, pain severity at least 5 on a 0-10 scale, and pain is primarily musculoskeletal/mechanical. Exclusion criteria: Acute and cancer pain, neuropathic etiology, severe psychopathology, active substance abuse, significant cognitive deficit, and previous participant of the pilot study on hypnosis and chronic low back pain. Outcome measures that will be administered pre- and post-intervention include: Brief Pain Inventory, Numeric Rating Scale, Pittsburgh Sleep Quality Scale, McGill Pain Questionnaire, Pain Quality Assessment Scale, Rand MHI-5, Hypnosis Treatment Outcome Measure, and the Two-Item Measures of Pain Beliefs and Coping Strategies. A process measure is the frequency of home practice.

Conditions

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Low Back Pain, Recurrent

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Arm 1 Hyp-8

Single-site study at MEDVA-Houston Behavioral: 8 weeks 1-hour hypnosis with hypnotherapist without audio recordings

Group Type EXPERIMENTAL

Hyp-8

Intervention Type BEHAVIORAL

8 weekly 1-hour sessions of therapist-guided hypnosis

Arm 2 Hyp-8 w recordings

Single-site study at MEDVA-Houston Behavioral: 8 weeks 1-hour hypnosis with hypnotherapist with audio recordings

Group Type EXPERIMENTAL

Hyp-2 w recordings

Intervention Type BEHAVIORAL

2 weeks of 1-hour sessions of therapist-guided hypnosis + 6 weeks of daily home practice with hypnosis CDs

Hyp-8

Intervention Type BEHAVIORAL

8 weekly 1-hour sessions of therapist-guided hypnosis

Hyp-8 w recordings

Intervention Type BEHAVIORAL

8 weekly 1-hour sessions of therapist-guided hypnosis + daily home practice with hypnosis CDs

Arm 3 Hyp-2 w recordings

Single-site study at MEDVA-Houston Behavioral: 2 weeks 1-hour hypnosis with hypnotherapist with audio recordings

Group Type EXPERIMENTAL

Hyp-2 w recordings

Intervention Type BEHAVIORAL

2 weeks of 1-hour sessions of therapist-guided hypnosis + 6 weeks of daily home practice with hypnosis CDs

Hyp-8

Intervention Type BEHAVIORAL

8 weekly 1-hour sessions of therapist-guided hypnosis

Hyp-8 w recordings

Intervention Type BEHAVIORAL

8 weekly 1-hour sessions of therapist-guided hypnosis + daily home practice with hypnosis CDs

Arm 4 BIO

Single-site study at MEDVA-Houston Behavioral: 8 weeks 1-hour EMG biofeedback without audio recordings

Group Type ACTIVE_COMPARATOR

BIO

Intervention Type BEHAVIORAL

8 weekly 1-hour sessions of EMG Biofeedback without hypnotic suggestion

Interventions

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Hyp-8

8 weekly 1-hour sessions of therapist-guided hypnosis

Intervention Type BEHAVIORAL

Hyp-2 w recordings

2 weeks of 1-hour sessions of therapist-guided hypnosis + 6 weeks of daily home practice with hypnosis CDs

Intervention Type BEHAVIORAL

Hyp-8

8 weekly 1-hour sessions of therapist-guided hypnosis

Intervention Type BEHAVIORAL

Hyp-8 w recordings

8 weekly 1-hour sessions of therapist-guided hypnosis + daily home practice with hypnosis CDs

Intervention Type BEHAVIORAL

Hyp-2 w recordings

2 weeks of 1-hour sessions of therapist-guided hypnosis + 6 weeks of daily home practice with hypnosis CDs

Intervention Type BEHAVIORAL

Hyp-8

8 weekly 1-hour sessions of therapist-guided hypnosis

Intervention Type BEHAVIORAL

Hyp-8 w recordings

8 weekly 1-hour sessions of therapist-guided hypnosis + daily home practice with hypnosis CDs

Intervention Type BEHAVIORAL

BIO

8 weekly 1-hour sessions of EMG Biofeedback without hypnotic suggestion

Intervention Type BEHAVIORAL

Other Intervention Names

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Arm 1 Arm 3 Arm 1 Arm 2 Arm 3 Arm 1 Arm 2 Arm 4

Eligibility Criteria

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Inclusion Criteria

* Chronic low back pain for at least 6 months
* Pain severity at least 5 on a 0-10 scale
* Pain is primarily musculoskeletal/mechanical
* Adults, at least 18 years of age

Exclusion Criteria

* Acute and cancer pain
* Neuropathic etiology
* Severe psychopathology
* Active substance abuse
* Significant cognitive deficit
* Previous participant of the pilot study on hypnosis chronic low back pain
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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VA Office of Research and Development

FED

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Wright Williams, PhD

Role: PRINCIPAL_INVESTIGATOR

Michael E. DeBakey VA Medical Center, Houston, TX

Locations

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Michael E. DeBakey VA Medical Center, Houston, TX

Houston, Texas, United States

Site Status

Countries

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United States

Other Identifiers

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H-18610

Identifier Type: OTHER

Identifier Source: secondary_id

D4421-I

Identifier Type: -

Identifier Source: org_study_id

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