University of Michigan / Wayne State Chronic Pain Study

Study Overview
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Brief Summary
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This study is designed to determine if a brief educational program can alter the attitudes and knowledge of individuals with chronic back pain, which is likely to be non-structural in nature. Individuals will be randomly assigned to an experimental condition (performs written educational and emotional awareness exercises) or a control condition (completes a general health activities questionnaire). Comparisons will be made to assess the degree of centralized pain features and functional improvements at 1-month follow-up. A 10-month follow-up as a secondary endpoint is also planned.

Official Title
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Openness to Cognitive Approach of Nonspecific Chronic Pain

Conditions
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Chronic Musculoskeletal Pain

Intervention / Treatment
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* Behavioral: Pain neuroscience education patient exercise
* Behavioral: Health behavior control intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: English-speaking adults ages 18 years or older with internet access who are referred to the University of Michigan Health Service Physical Medicine and Rehabilitation Spine Program identified the physician with chronic nonspecific back pain (longer than 3 months) or fibromyalgia. Degenerative changes seen on imaging are considered nonspecific. Alternatively, enrolled in the University of Michigan Health Research Volunteer Pool with a profile that includes chronic low back pain or fibromyalgia. Exclusion Criteria: Any signs of a serious underlying condition (cancer, infection, cauda equine), spinal stenosis or radiculopathy, or other specific spinal cause (vertebral compression fracture or ankylosing spondylitis). Those patients who are being considered for an interventional spine procedures or surgical consults would not be included in this study. Individuals receiving or applying for compensation or disability, the inability to provide written informed consent, severe physical impairment (e.g. blindness, deafness), co-morbid medical condition limiting function (e.g. malignant cancer), the use of illicit drug use, or a psychiatric condition that would limit judgment.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Chronic Pain and the Brain<br>This condition is a 15 to 20-minute exercise that patients complete in which they examine variables in themselves that suggest that their pain is driven by central nervous system processes / their brains. | Behavioral: Pain neuroscience education patient exercise<br>* Patients complete a 15 to 20-minute on-line exercise that inquires about 5 domains: the degree of central sensitization symptoms, catastrophizing and kinesiophobia, personality factors, stressors that triggered or exacerbated the pain, and adverse childhood experiences.<br>|
| Placebo Comparator: Health Behavior Control<br>This 15 to 20-minute exercise is designed as a control condition that has face validity as helpful and that relates to health. Thus, patients are asked to examine various domains of their own health behavior as engaged in over the past 24 hours (e.g., nutrition, sleep, exercise, hygiene, social connections). | Behavioral: Health behavior control intervention<br>* Patients engage in a 15 to 20-minute on-line exercise examining their health behaviors in five domains: exercise, sleep, diet, hygiene, and social connections.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Brief Pain Inventory | Self-reported pain and dysfunction | Change from baseline to 1-Month follow-up (with secondary 10-month follow-up) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient-Reported Outcomes Measurement Information System: Depression short form 8b | Self-reported depression | Change from baseline to 1-Month follow-up (with secondary 10-month follow-up) | 
| Patient-Reported Outcomes Measurement Information System: Anxiety short form 8a | Self-reported anxiety | Change from baseline to 1-Month follow-up (with secondary 10-month follow-up) | 
| Patient-Reported Outcomes Measurement Information System: Anger short form 5a | Self-reported anger | Change from baseline to 1-Month follow-up (with secondary 10-month follow-up) | 
| Pain attributions questionnaires | Two self-report questionnaires were developed to assess psychological and brain influences on pain. The 4-item psychological attribution scale assesses patients' beliefs that their thoughts and feelings and psychological therapy impacts pain, and the 3-item brain attribution scale assesses patient's beliefs that their pain is brain-based. Mean scores will be computed for both scales separately (0-4; higher scores indicating greater belief that pain is a brain-related [brain attribution] construct and that pain is affected by thoughts, feelings, and psychological interventions [psychological attribution]) | Change from baseline to 1-Month follow-up (with secondary 10-month follow-up) | 
| Pain Stages of Change Questionnaire | The Pain Stages of Change questionnaire (Kerns, Rosenberg, Jamison, Caudill, & Haythornthwaite, 1997): an overall readiness score will be calculated using mean scores of the four subscales. Readiness is the sum of patient mean ratings for contemplation (C; 1-5), action (A; 1-5), and maintenance (M; 1-5), minus the mean score for precontemplation (PC; 1-5): C + A + M - PC = Readiness. Higher scores indicate greater readiness. | Change from baseline to 1-Month follow-up (with secondary 10-month follow-up) | 
| Pain Catastrophizing Scale | Pain Catastrophizing Scale (Sullivan et al., 1995): A summed score of the 13 catastrophizing items will be computed (0-52, higher scores indicate greater catastrophizing) | Change from baseline to 1-Month follow-up (with secondary 10-month follow-up) | 
| Tampa Scale for Kinesiophobia | The Tampa Kinesiophobia Scale (Miller, Kori, &Todd, 1991): A mean score of the 11 items will be computed (1-4, higher scores indicating greater kinesiophobia) | Change from baseline to 1-Month follow-up (with secondary 10-month follow-up) | 
| Satisfaction with Life Scale | The Satisfaction with Life Scale (Emmons, Larsen, & Griffin, 1985): A mean score of the 5 items will be computed (1-7, higher scores indicating greater life satisfaction) | Change from baseline to 1-month follow-up (with secondary 10-month follow-up) |