Single Session Pain Psychology Treatment: Comparative Efficacy & Mechanisms

NCT ID: NCT03167086

Last Updated: 2020-10-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

263 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-06-08

Study Completion Date

2020-08-18

Brief Summary

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This study aims to compare the efficacy of a single session psychological treatment, "Empowered Relief" (ER), with the current standard of care, group Cognitive Behavioral Therapy (CBT) specifically on individuals with chronic low back pain who have pain-specific distress as indexed by pain catastrophizing scores.

Detailed Description

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This is a randomized 3-arm study comprised of 2 active psychological treatments (ER \& CBT) and a health education (HE) arm that controls for time and attention. Study goals are to provide scientific evidence to demonstrate the efficacy of ER, and also provide a comparison of said efficacy against the current gold standard group treatment for PC -- manualized 8-session pain-CBT.

Conditions

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Chronic Low Back Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The design is a randomized 3-arm study comprised of 2 active psychological treatments (ER \& CBT) and a health education (HE) arm that controls for time and attention.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Principal Investigators and Statisticians performing analyses will be blinded.

Study Groups

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Single Session Skills-Based Pain Psychology Class

"Empowered Relief (ER)": A single-session skills-based approximately 2-hr group intervention for chronic pain.

Group Type EXPERIMENTAL

"Empowered Relief" (ER)

Intervention Type BEHAVIORAL

"Empowered Relief (ER)": A single-session skills-based approximately 2-hr group intervention to treat chronic pain.

Format of intervention: Therapist-delivered PowerPoint presentation with experiential exercises. Experienced senior level psychologist and two (2) additional doctoral level psychologists will conduct the ER sessions.

Content of intervention: ER Participants have the 'ER Relaxation Resource' app (guided relaxation audiofile) loaded on their apple or android electronic device.

Cognitive Behavioral Therapy (CBT)

8-week Manualized Pain-CBT Group Intervention will be delivered by PhD-level psychotherapists (3 in total).

Group Type ACTIVE_COMPARATOR

Cognitive Behavioral Therapy (CBT)

Intervention Type BEHAVIORAL

Format of intervention: 8-week Manualized Pain-CBT Group Intervention will be delivered by PhD-level psychotherapists (3 in total). The group is run weekly for 8 consecutive classes. Each class is 2 hours with a midpoint break (16 hours total intervention time).

Content of intervention: The protocol and materials were developed with funding from NIH/NCCAM R01 AT006226 (Dan Cherkin, PI) \[1\& 2\], and include content from a pain-CBT program developed by Drs. Ehde, Dillworth, and Turner \[3\].

Participants receive a workbook with homework and a copy of The Pain Survival Guide: How to reclaim your life © 2005 by Turk \& Winter \[4\] for optional reading.

Health Education (HE)

The active control treatment arm consists only of Health Education and has no psychological treatment components. It is a 2-hour HE class matched to the single-session psychological experimental arm (ER) on 4 important factors: duration, structure, format and site.

Group Type ACTIVE_COMPARATOR

Health Education (HE)

Intervention Type BEHAVIORAL

Format of intervention: The HE class will be instructor taught and will involve a PowerPoint presentation and handouts. Two additional providers will be identified and trained to conduct the sessions. Selected instructors will have substantial health education experience.

Content of intervention: HE content will include basic information such as nutrition and interacting with the healthcare system; these relatively 'inert' topics are unlikely to impart any specific effects typically found with a true psychobehavioral intervention.

Interventions

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"Empowered Relief" (ER)

"Empowered Relief (ER)": A single-session skills-based approximately 2-hr group intervention to treat chronic pain.

Format of intervention: Therapist-delivered PowerPoint presentation with experiential exercises. Experienced senior level psychologist and two (2) additional doctoral level psychologists will conduct the ER sessions.

Content of intervention: ER Participants have the 'ER Relaxation Resource' app (guided relaxation audiofile) loaded on their apple or android electronic device.

Intervention Type BEHAVIORAL

Cognitive Behavioral Therapy (CBT)

Format of intervention: 8-week Manualized Pain-CBT Group Intervention will be delivered by PhD-level psychotherapists (3 in total). The group is run weekly for 8 consecutive classes. Each class is 2 hours with a midpoint break (16 hours total intervention time).

Content of intervention: The protocol and materials were developed with funding from NIH/NCCAM R01 AT006226 (Dan Cherkin, PI) \[1\& 2\], and include content from a pain-CBT program developed by Drs. Ehde, Dillworth, and Turner \[3\].

Participants receive a workbook with homework and a copy of The Pain Survival Guide: How to reclaim your life © 2005 by Turk \& Winter \[4\] for optional reading.

Intervention Type BEHAVIORAL

Health Education (HE)

Format of intervention: The HE class will be instructor taught and will involve a PowerPoint presentation and handouts. Two additional providers will be identified and trained to conduct the sessions. Selected instructors will have substantial health education experience.

Content of intervention: HE content will include basic information such as nutrition and interacting with the healthcare system; these relatively 'inert' topics are unlikely to impart any specific effects typically found with a true psychobehavioral intervention.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Axial low back pain without radicular symptoms
* Pain duration ≥ 6 months (per recent NIH Task Force on Research Standards for Chronic Low Back Pain based on participant self-report
* Average pain intensity ≥4/10 for the past month at screening visit
* English fluency
* Males and females 18-70 years of age
* Pain Catastrophizing Score (PCS) ≥20

Exclusion Criteria

* Gross cognitive impairment
* Active suicidal ideation or severe depression
* Previous attendance in the active treatment groups (any ER classes ever taken or CBT in the past 3 years)
* Participating in any interventional research study or completed participation in the last 2 months; enrollment in an observational study is acceptable
* Current substance abuse
* Clear likelihood to disrupt fellow class participants (e.g., personality disorder) at the discretion of the study team
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Stanford University

OTHER

Sponsor Role lead

Responsible Party

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Beth Darnall

Clinical Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Beth Darnall, PhD

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Sean Mackey, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Locations

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Stanford University, Systems Neuroscience and Pain Lab

Palo Alto, California, United States

Site Status

Countries

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United States

References

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1. Stoelb, B., Balderson, B., Turner, J.A., Mind-Body Approaches to Pain Management (MAP) Study: CBT Therapist Manual. 2012, Seattle, WA: Group Health Research Institute. (Developed with funding from NIH/NCCAM R01 AT006226; Dan Cherkin, PhD, Principal investigator).

Reference Type BACKGROUND

2. Stoelb, B., Balderson, B., Turner, J.A., Mind-Body Approaches to Pain Management (MAP) Study: CBT Patient Workbook. 2012, Seattle, WA: Group Health Research Institute (Developed with funding from NIH/NCCAM R01 AT006226; Dan Cherkin, PhD, Principal Investigator).

Reference Type BACKGROUND

3. Ehde, D.M., Dillworth, T. M., & Turner, J.A. , Cognitive-Behavioral Therapy Manual for the Telephone-Delivered Intervention for Pain Study (Unpublished treatment manual). 2012.

Reference Type BACKGROUND

4. Turk, D.C., Winter, F., The Pain Survival Guide: How to reclaim your life. 2005, Washington, D.C.: American Psychological Association.

Reference Type BACKGROUND

Darnall BD, Roy A, Chen AL, Ziadni MS, Keane RT, You DS, Slater K, Poupore-King H, Mackey I, Kao MC, Cook KF, Lorig K, Zhang D, Hong J, Tian L, Mackey SC. Comparison of a Single-Session Pain Management Skills Intervention With a Single-Session Health Education Intervention and 8 Sessions of Cognitive Behavioral Therapy in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2021 Aug 2;4(8):e2113401. doi: 10.1001/jamanetworkopen.2021.13401.

Reference Type DERIVED
PMID: 34398206 (View on PubMed)

Darnall BD, Ziadni MS, Roy A, Kao MC, Sturgeon JA, Cook KF, Lorig K, Burns JW, Mackey SC. Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial. Trials. 2018 Mar 6;19(1):165. doi: 10.1186/s13063-018-2537-3.

Reference Type DERIVED
PMID: 29510735 (View on PubMed)

Other Identifiers

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R01AT008561

Identifier Type: NIH

Identifier Source: org_study_id

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