Can we improve cognitive–behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy.

Kerns, Robert D.; Burns, John W.; Shulman, Marc J.; Jensen, Mark P.; Nielson, Warren R.; Czlapinski, Rebecca; Dallas, Mary I.; Chatkoff, David K.; Sellinger, John; Heapy, Alicia; Rosenberger, Patricia H.

doi:10.1037/a0034406

Cited by 78 publications

(87 citation statements)

References 26 publications

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“…In comparison with other studies, adherence for CBT for chronic back pain has shown to be associated with treatment gains in a variety of outcome measures including accomplishment of daily goals. 142 Attendance was good, with 23 participants (88%) attending at least half of the sessions.…”

Section: Best Usual Carementioning

confidence: 99%

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Ellard

Underwood

Achana

et al. 2017

Health Technol Assess

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BackgroundThe National Institute for Health and Care Excellence (NICE) 2009 guidelines for persistent low back pain (LBP) do not recommend the injection of therapeutic substances into the back as a treatment for LBP because of the absence of evidence for their effectiveness. This feasibility study aimed to provide a stable platform that could be used to evaluate a randomised controlled trial (RCT) on the clinical effectiveness and cost-effectiveness of intra-articular facet joint injections (FJIs) when added to normal care.ObjectivesTo explore the feasibility of running a RCT to test the hypothesis that, for people with suspected facet joint back pain, adding the option of intra-articular FJIs (local anaesthetic and corticosteroids) to best usual non-invasive care is clinically effective and cost-effective.DesignThe trial was a mixed design. The RCT pilot protocol development involved literature reviews and a consensus conference followed by a randomised pilot study with an embedded mixed-methods process evaluation.SettingFive NHS acute trusts in England.ParticipantsParticipants were patients aged ≥ 18 years with moderately troublesome LBP present (> 6 months), who had failed previous conservative treatment and who had suspected facet joint pain. The study aimed to recruit 150 participants (approximately 30 per site). Participants were randomised sequentially by a remote service to FJIs combined with ‘best usual care’ (BUC) or BUC alone.InterventionsAll participants were to receive six sessions of a bespoke BUC rehabilitation package. Those randomised into the intervention arm were, in addition, given FJIs with local anaesthetic and steroids (at up to six injection sites). Randomisation occurred at the end of the first BUC session.Main outcome measuresProcess and clinical outcomes. Clinical outcomes included a measurement of level of pain on a scale from 0 to 10, which was collected daily and then weekly via text messaging (or through a written diary). Questionnaire follow-up was at 3 months.ResultsFifty-two stakeholders attended the consensus meeting. Agreement informed several statistical questions and three design considerations: diagnosis, the process of FJI and the BUC package and informing the design for the randomised pilot study. Recruitment started on 26 June 2015 and was terminated by the funder (as a result of poor recruitment) on 11 December 2015. In total, 26 participants were randomised. Process data illuminate some of the reasons for recruitment problems but also show that trial processes after enrolment ran smoothly. No between-group analysis was carried out. All pain-related outcomes show the expected improvement between baseline and follow-up. The mean total cost of the overall treatment package (injection £419.22 and BUC £264.00) was estimated at £683.22 per participant. This is similar to a NHS tariff cost for a course of FJIs of £686.84.LimitationsPoor recruitment was a limiting factor.ConclusionsThis feasibility study achieved consensus on the main challenges in a trial of FJIs for people with persistent non-specific low back pain.Future workFurther work is needed to test recruitment from alternative clinical situations.Trial registrationEudraCT 2014-000682-50 and Current Controlled Trials ISRCTN93184143.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 30. See the NIHR Journals Library website for further project information.

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Section: Best Usual Carementioning

confidence: 99%

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Ellard

Underwood

Achana

et al. 2017

Health Technol Assess

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“…Various studies examining CBT as a treatment modality for chronic pain have demonstrated reductions in patient pain severity, disability, distress, and healthcare use in relation to their pain experience (Kerns et al 2013). There are some very close similarities between the CBT modalities when targeting pain, and each aims for psychological flexibility and adaptive cognitive and behavioral pursuits.…”

Section: Best Treatment Of Catastrophizingmentioning

confidence: 98%

“…Impacting the efficacy of self-management and self-efficacy focused interventions are motivational factors often cited in Prochaska's stages of change model and Motivational Interviewing. A patient's readiness to adopt a self-management approach impacts the adherence and dropout rates of such interventions (Kerns et al 2013). The self-management and self-efficacy approach is not uniform in effectiveness however.…”

Section: Self-management and Self-efficacymentioning

confidence: 99%

The Role of Catastrophizing Beliefs in Effective Chronic Pain Treatment

Smith¹,

Herman²,

Smith³

2015

J Rat-Emo Cognitive-Behav Ther

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Chronic pain is a serious and complex health issue. Patients dealing with chronic pain demonstrate multifarious behavioral and cognitive responses to their widely varying individual experiences. How can we, as health professionals, best serve these patients? In this paper, we discuss the place of pain within the historical conceptualization of health and normalcy, and the more current biopsychosocial model. We also review contemporary theories on how cognition plays a vital role in the psychological processing of stimuli, including pain. We focus on the significant interactions between catastrophizing appraisals of pain and the chronic pain experience, including increases in pain perception, pain sensitivity, depression and disability. In light of these significant interactions, we assert that catastrophizing must be specifically addressed in the treatment of chronic pain. We therefore explore the mechanisms through which catastrophizing comes to influence the pain experience, and its etiology. Then, with an understanding of cognitive processing of stimuli, along with the causes and consequences of catastrophizing, we suggest several targets of treatment for catastrophizing in chronic pain. We explore how the cognitive models meet or fail to meet those targets. We conclude with suggestions for further research on the topic of catastrophizing and chronic pain.

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“…This could be particularly powerful when combined with deliberate intervention tailoring. For example, allowing individuals to pick from a menu of self-management strategies may be as effective as the clinician picking which strategies are used, (46) but has the potential to be more feasible and acceptable to patients. Further investigation into such interventions among HIV-infected individuals with chronic pain is needed.…”

Section: Discussionmentioning

confidence: 99%

(495) Pain self-management in HIV-infected individuals with chronic pain: a qualitative study

Merlin

Bair

Kerns

et al. 2015

The Journal of Pain

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Objective-Chronic pain in individuals with HIV is a common, impairing condition. Behavioral interventions for chronic pain specifically tailored to this population have yet to be developed. We assert that understanding self-management strategies already used by persons living with these conditions is an essential first step, and is the objective of this investigation.Design-We conducted a thematic analysis of qualitative data from 25 in-depth interviews with individuals with HIV and chronic pain.Results-The primary pain self-management strategies articulated by participants were: physical activity; cognitive and spiritual strategies; spending time with family and friends and social support; avoidance of physical/social activity; medication-centric pain management; and substance use.

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Can we improve cognitive–behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy.

Cited by 78 publications

References 26 publications

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

The Role of Catastrophizing Beliefs in Effective Chronic Pain Treatment

(495) Pain self-management in HIV-infected individuals with chronic pain: a qualitative study

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