Category: Treatment - CBT

Symposium

Symposium 21 - Demonstrating the Effectiveness of Group CBT and Pain Education for Multiply Disadvantaged Patients

Friday, November 17
10:15 AM - 11:45 AM
Location: Cobalt 501, Level 5, Cobalt Level

Keywords: Pain | Treatment-CBT | Randomized Controlled Trial
Presentation Type: Symposium

Chronic pain is a widespread, costly, and growing problem in the U.S, which disproportionately affects individuals with low-socioeconomic status (SES). Financially disadvantaged individuals face numerous challenges that exacerbate the negative effects of chronic pain and reduce the effectiveness of treatments. These patients tend to experience higher rates of chronic pain and psychological comorbidities such as depression and anxiety, lack comprehensive health care resources, experience high levels of stress, and have lower literacy and education levels. Additionally, this patient population is more likely to be non-white, have lower literacy, and lower educational attainment, which compound the barriers they face when seeking treatment for their chronic pain.

Psychosocial interventions for chronic pain are promising but are based primarily on middle-class patients with high literacy levels, and are usually heavily reliant on written patient material and homework. Very few attempts have been made to evaluate or adapt these treatments in disadvantaged populations. Although the potential positive impact of psychosocial treatments is large, the difficulty of providing treatments that are adapted for low-literacy and low-SES patients suffering many healthcare inequalities presents significant implementation obstacles related to logistics, resources, and healthcare culture.

The Learning About My Pain (LAMP) is one of the largest randomized, controlled, comparative-effectiveness trial of psychosocial interventions for chronic pain in low-income settings (PCORI Contract #941, Beverly Thorn, PI). A total of 290 participants with chronic pain were randomly assigned to either group-administered cognitive-behavioral therapy (CBT), pain education (EDU), or treatment-as-usual (TAU). The two group psychosocial treatments were adapted to reduce the cognitive demands of the interventions by lowering the literacy level of the patient materials, use of interactive teaching techniques and avoidance of jargon, and supplementing with audio materials. This symposium reviews the quantitative and qualitative outcomes of the trial, healthcare utilization and opioids before and after treatment, and heterogeneity of treatment effects.

The patient population reached by the LAMP study is widely thought to be difficult or impossible to recruit and retain, noncompliant, or hard to teach because of low education levels. This study dispels these biases by demonstrating that, in a population of multiply disadvantaged patients with chronic pain, literacy-adapted psychosocial treatments are effective, and engagement/retention rates strongly support the acceptability and feasibility of the interventions.

Learning Objectives:

Send Email for Beverly Thorn

Send Email for John Burns

Send Email for Beverly Thorn

Send Email for Calia Torres

Send Email for Andrea Newman

Send Email for Benjamin Van Dyke


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