Category: Treatment - CBT

Symposium

Literacy-Adapted CBT Versus Pain Education Versus Usual Care in Adults With Chronic Pain at Low-Income Clinics

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

Keywords: Pain | Randomized Controlled Trial | Psychotherapy Outcome
Presentation Type: Symposium

Background: Chronic pain is a major public health problem, unequally borne by low-SES individuals. Treatment is mostly biomedical and expensive, with undesirable side effects. Psychosocial treatments show promise as adjuncts or alternatives, but are often unavailable to low-SES patients and have not been adapted for lower education or literacy levels that are disproportionately observed in poor populations.


Methods: 290 participants receiving treatment for chronic pain from low-income health clinics in AL were randomized to literacy-adapted group cognitive-behavioral therapy (CBT), similarly adapted pain education based on the biopsychosocial model (EDU), or a medical treatment-as-usual group (TAU). Interventions were 10 weekly 90-min. sessions. Assessments were conducted at baseline, 5 weeks, 10 weeks, and 6-months. The primary outcome was pain severity; secondary outcomes were interference in daily activities due to pain and depression. Analyses used intention-to-treat approach. Piecewise linear growth models examined changes over time in outcomes and differences between treatment conditions. Logistic regression examined differences between conditions on clinically meaningful improvements (≥ 30%).


Results: Pain severity, pain interference, and depression decreased significantly from pre- to post-treatment for participants randomized to both CBT and EDU (medium effect size for both), with treatment gains maintained at 6-month follow-up. TAU participants did not show significant change in pain severity across time. CBT produced more treatment effects that were clinically meaningful.


Conclusion: Among adults attending a low-income community health clinic, both literacy-adapted CBT and EDU resulted in significant improvements in pain severity, interference, and depression, which were largely maintained from post-treatment to follow-up, whereas TAU did not. Differential treatment benefits of CBT over EDU for pain severity, interference, and depression suggest that it has a valued-added advantage over EDU. However, EDU focused on the biopsychosocial model may provide an alternative to usual medical treatment alone in low-income clinics that may not have the resources to implement CBT.

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