Cognitive Behavioral Chronic Pain Trial Among Rural Minorities and non-Minorities

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DESCRIPTION (provided by applicant): Individuals living in a rural area have a high occurrence of chronic pain. Cognitive Behavioral Therapy (CBT) is a widely accepted evidence-based psychosocial treatment for chronic pain; its efficacy has been well established in multiple randomized clinical trials. However, there is no research testing the treatment efficacy of psychosocial interventions for chronic pain in rural populations. The primary objective of the proposed study (R21) is to test the efficacy of CBT compared to education attention control for rural individuals with chronic pain (ICPs). Ten weekly sessions of CBT or education treatment will be provided in small group format (6-8 individuals) at two rural health clinics for patients suffering from chronic pain. Treatment implementation measures will be used to ensure that therapists are delivering the treatment as planned and that patients understand and implement the treatment suggestions. The specific aims of this study are as follows: 1) To test the efficacy of CBT group treatment for rural ICPs, we will compare CBT outcomes to an education attention control condition. We hypothesize that participants in the CBT condition will report greater improvements in pain related outcomes (pain severity, perceived disability, depression, and quality of life) than control participants. 2) To test the mediational role of catastrophizing, a negative mental set about pain, on treatment outcomes in a rural population. We hypothesize that pain catastrophizing will mediate treatment outcome measures obtained at the end of treatment. A Secondary Aim is to explore potential differences in treatment outcome and treatment-related variables (treatment satisfaction, session attendance rate, drop out rate, and the ratio of invited participants versus those who participate) based on gender, education, income, and ethnicity. Providing CBT to rural ICPs is consistent with Healthy People 2010's two overarching goals of increasing the quality and years of healthy life and eliminating health disparities (DHHS, 2000). Rural citizens have a high incidence of chronic pain problems and they lack access to health care. Although psychosocial treatments for chronic pain have proven effective in urban populations, they have not been systematically tested in rural populations. This study will test the effectiveness of cognitive-behavioral treatment for chronic pain in two rural Alabama health clinics with a high percentage of African Americans.