Telephone Cognitive Behavior Therapy for OEF Veterans With Pain
Condition: Chronic Pain
MeSH terms: Chronic Pain
Study type: Interventional

Summary: 
      We conducted a randomized clinical trial comparing telephone-delivered cognitive behavior
      therapy and pain education control. We enrolled 41 OEF/OIF/OND veterans with chronic pain and
      randomizing them into one of two treatment conditions. The study sample was recruited from
      primary care clinics at the San Francisco VA Medical Center and affiliated VA community-based
      outpatient clinics (CBOCs) in downtown San Francisco, Clearlake, Eureka, San Bruno, Santa
      Rosa, and Ukiah. Recruitment targeted OEF/OIF/OND veterans with pain disorders that involved
      muscle strain and inflammation, trauma to nerves, and/or central nervous system dysfunction.
      Both interventions were delivered by telephone and consisted of 12 sessions scheduled over a
      20-week period. Pain management outcomes were measured at 10 weeks (mid-treatment), 20 weeks
      (post-treatment), 32 weeks (3-month follow-up), and 46 weeks (6-month follow-up). The sample
      size was chosen to provide greater than 80% power at a two-tailed alpha of 0.05. The study
      hypothesis, assessment methodology, and intervention procedures were based on the
      cognitive-behavioral model of chronic pain.
    

Detailed description: 
      In the VHA, over 50% of OEF/OIF/OND veterans who are seen in primary care settings report
      disabling pain symptoms. Although cognitive behavior therapy (CBT) is now commonly employed
      within interdisciplinary pain management programs, access to these interventions is often
      limited due to the distance from clinical care and disabling impact of pain. In addition, the
      dropout rate in studies of face-to-face CBT for chronic pain further detracts from its impact
      in pain management. A telephone-delivered version of CBT for chronic pain overcomes these
      barriers to access.

      Primary Aim: to investigate the effectiveness of telephone CBT in the management of chronic
      pain with OEF/OIF/OND veterans enrolled in VA primary care clinics.

      Secondary Aim: to determine moderator and mediating factors by which telephone CBT
      facilitates pain management and successful adjustment of OEF/OIF/OND veterans to chronic
      pain.

      Major hypothesis:

      Hypothesis 1: Patients who receive telephone CBT will show significantly greater improvements
      in coping skills, reduced emotional distress, and increased quality of life compared with
      those who participate in telephone pain education (EDU).

      Hypothesis 2: The dropout rate for both of the telephone interventions in this study will be
      significantly lower than the attrition rate found in previous studies of face-to-face CBT for
      chronic pain.

      Secondary hypothesis:

      Hypothesis 3: An increase in use of coping skills will be positively associated with
      treatment outcome measures reflecting improved adjustment to chronic pain.

      Hypothesis 4: A decrease in catastrophizing will be positively associated with treatment
      outcome measures reflecting improved adjustment to chronic pain.

      To accomplish these aims, we conducted a randomized clinical trial comparing
      telephone-delivered cognitive behavior therapy and pain education control. A total of 42
      OEF/OIF/OND veterans with chronic pain were enrolled in the study and randomized into one of
      two treatment conditions. The study sample was recruited from primary care clinics at the San
      Francisco VA Medical Center and affiliated VA community-based outpatient clinics (CBOCs) in
      downtown San Francisco, Eureka, San Bruno, Santa Rosa, and Ukiah. Recruitment targeted
      OEF/OIF/OND veterans with pain disorders that involved muscle strain and inflammation, trauma
      to nerves, and/or central nervous system dysfunction. Both interventions were delivered by
      telephone and consisted of 12 sessions scheduled over a 20-week period. Pain management
      outcomes were measured at 10 weeks (mid-treatment), 20 weeks (post-treatment), 32 weeks
      (3-month follow-up), and 46 weeks (6-month follow-up). The sample size was chosen to provide
      greater than 80% power at a two-tailed alpha of 0.05. The study hypothesis, assessment
      methodology, and intervention procedures were based on the cognitive-behavioral model of
      chronic pain.
    

Intervention name(s): Telephone cognitive behavior therapy; Telephone pain education
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Cognitive behavior therapy aimed at teaching pain coping skills was conducted by telephone (12 sessions over a 6-month period).; Participants received information on the management of chronic pain during 12 telephone sessions conducted over a 6-month period).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: pain; chronic pain; cognitive therapy; telehealth