title: Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain.
abstract: Chronic pain is a common and costly experience. Cognitive behavioral therapies (CBT) are efficacious for an array of chronic pain conditions. However, the literature is based primarily on urban (white) samples. It is unknown whether CBT works in low-socioeconomic status (SES) minority and nonminority groups. To address this question, we conducted a randomized controlled trial within a low-SES, rural chronic pain population. Specifically, we examined the feasibility, tolerability, acceptability, and efficacy of group CBT compared with a group education intervention (EDU). We hypothesized that although both interventions would elicit short- and long-term improvement across pain-related outcomes, the cognitively-focused CBT protocol would uniquely influence pain catastrophizing. Mixed design analyses of variance were conducted on the sample of eligible participants who did not commence treatment (N=26), the intention-to-treat sample (ITT; N=83), and the completer sample (N=61). Factors associated with treatment completion were examined. Results indicated significantly more drop-outs occurred in CBT. ITT analyses showed that participants in both conditions reported significant improvement across pain-related outcomes, and a nonsignificant trend was found for depressed mood to improve more in CBT than EDU. Results of the completer analyses produced a similar pattern of findings; however, CBT produced greater gains on cognitive and affect variables than EDU. Treatment gains were maintained at 6-month follow-up (N=54). Clinical significance of the findings and the number of treatment responders is reported. Overall, these findings indicate that CBT and EDU are viable treatment options in low-SES minority and nonminority groups. Further research should target disseminating and sustaining psychosocial treatment options within underserved populations.
authors.affiliation: Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA Department of Psychiatry and Behavioral Medicine, The University of Alabama School of Medicine, Tuscaloosa, AL, USA Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA The Rehabilitation Center, 2610 East 7th Street, Charlotte, NC 28204-4375, USA Psychology Service, V.A. Medical Center, Tuscaloosa, AL, USA.
authors.forename: Beverly E
authors.initials: BE
authors.lastname: Thorn
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Day
authors.forename: John
authors.initials: J
authors.lastname: Burns
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Kuhajda
authors.forename: Susan W
authors.initials: SW
authors.lastname: Gaskins
authors.forename: Kelly
authors.initials: K
authors.lastname: Sweeney
authors.forename: Regina
authors.initials: R
authors.lastname: McConley
authors.forename: Charles L
authors.initials: CL
authors.lastname: Ward
authors.forename: Chalanda
authors.initials: C
authors.lastname: Cabbil
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D059350:Chronic Pain / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D058980:Information Literacy; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D011615:Psychotherapy, Group / Q000379:methods*; D012424:Rural Population