Psychological Treatment of Disability-Related Pain: Efficacy and Mechanisms

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DESCRIPTION (provided by applicant): The long-term objectives of this research program are to develop and test innovative treatments for disability-related pain and increase our understanding of the mechanisms of the effects of these treatments in order to (1) maximize the effectiveness of psychological pain treatments and (2) better match individual patients to specific treatments. Evidence indicates that both cognitive therapy and self-hypnosis training can reduce chronic pain in individuals with disability-related pain. However, research on the long-term effects of these treatments as well as research studying the mechanism(s) of these treatments is lacking. Moreover, cognitive therapy and hypnosis may have synergistic effects; yet researchers have not yet tested whether a novel treatment that combines both enhances outcomes over either cognitive therapy or hypnosis alone. The proposed study will examine the efficacy of hypnotic cognitive therapy, relative to both an education control condition and to standard cognitive therapy and hypnosis, in order to determine if this new intervention benefits individuals with multiple sclerosis and spinal cord injury who have chronic pain. It will also test hypotheses related to three possible mechanisms of the active treatments. Specifically, the study will determine if their beneficial effects of the treatments occur because they (1) alter pai-related cognitive content, (2) alter pain- related cognitive coping, and (3) especially for hypnosi and hypnotic cognitive therapy, enhance brain states that are associated with pain relief. Analyses will test the hypothesis that (1) hypnotic cognitive therapy, cognitive therapy, and self-hypnosis training will result in larger pre- to post-treatment decreases in daily pain intensity thn an education control intervention, (2) hypnotic cognitive therapy will result in larger decreases i pain intensity than cognitive therapy or hypnosis, and (3) the beneficial effects of the three active treatments, relative to the control condition, will be mediated by changes in pain-related cognitive content, cognitive coping, and brain state (as measured by electroencephalogram). The findings from this study will increase our understanding of the efficacy and effects of three psychological treatments for chronic disability-related pain. The study findings will also contribute to our understanding of how and why psychological pain treatments work, providing an empirical foundation for enhancing their efficacy and matching patients to treatment. All of these outcomes will contribute to our long-term goal of increasing the availability of effective chronic pain treatments for individuals with physical disabilities. PUBLIC HEALTH RELEVANCE: By increasing our understanding of the efficacy of the three psychological pain treatments, the proposed project will benefit public health by providing an empirical basis for referring individuals with chronic pain, including individuals with disability-related chronic pain, to the most effective treatments. By increasing our understanding of the mechanisms by which these interventions have their beneficial effects, we will be better able to maximize the efficacy of pain treatments, by focusing on those mechanisms most responsible for treatment benefits. Moreover, such mechanism-based research can help translate research to practice by indentifying treatment components that are most essential when adapting pain treatments for specific clinical settings.