Chronic pain is a significant problem for many rheumatoid arthritis (RA) patients. Although cognitive-behavioral therapy (CBT) methods have only recently been applied to the management of arthritis pain, these methods appear to be promising. After completing CBT, many patients report significant reductions in pain and improvements in physical and psychological disability. Data from follow-up studies, however, indicate that while some patients are able to maintain treatment gains, many are not. Given the advantages of CBT (its low cost and minimal side effects) and its demonstrated promise, there is a need to explore new ways to help arthritis patients maintain and extend their initial treatment gains. The proposed study seeks to determine whether the effects of CBT can be enhanced by adding an innovative maintenance enhancement training intervention that features cognitive therapy methods for preventing relapse, training in self-control skills for maintaining frequent practice of coping skills, and behavioral rehearsal. 200 rheumatoid arthritis patients will be randomly assigned to one of four conditions: a) CBT for pain management, b) CBT plus maintenance enhancement training, c) arthritis education, or d) standard care control. A comprehensive set of outcome measures will be collected before and after the six month treatment phase of the study and at 6- and 18-months post-treatment. The study: l) will evaluate whether maintenance enhancement training helps patients maintain gains in pain, physical disability, psychological disability, and pain behavior, 2) will determine how changes in patients' sense of self-efficacy relate to long-term (18 months) improvements in pain and disability, and 3) will use newly-developed daily study methods to analyze the long-term effects of CBT on daily coping and daily perceived control over pain. If maintenance enhancement training is effective, future studies could evaluate this training in other populations having persistent pain (e.g. osteoarthritis, sickle cell disease, or cancer). Future studies could also identify the particular maintenance enhancement training components (e.g. cognitive therapy methods, behavioral rehearsal, or training in self-monitoring and self- reinforcement) that contribute most to treatment effects. By isolating the active ingredients of this training, one can streamline it, making it more cost-effective and thus more readily available to the large population of RA patients having persistent pain. The study proposed rigorously evaluates the effects of methods for enhancing the effects of CBT in arthritis patients. This study may lead to major advances in our understanding of arthritis pain and enlarge our repertoire of methods for effectively treating RA pain.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR042261-05
Application #
2457968
Study Section
Special Emphasis Panel (ZRG1-SSP (01))
Project Start
1993-08-01
Project End
1997-12-31
Budget Start
1997-08-01
Budget End
1997-12-31
Support Year
5
Fiscal Year
1997
Total Cost
Indirect Cost
Name
Duke University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
071723621
City
Durham
State
NC
Country
United States
Zip Code
27705
Schroeder, David; Korsakov, Fedor; Jolton, Joseph et al. (2013) Creating widely accessible spatial interfaces: mobile VR for managing persistent pain. IEEE Comput Graph Appl 33:82-9
Waters, Sandra J; Riordan, Paul A; Keefe, Francis J et al. (2008) Pain behavior in rheumatoid arthritis patients: identification of pain behavior subgroups. J Pain Symptom Manage 36:69-78
Carson, James W; Keefe, Francis J; Affleck, Glenn et al. (2006) A comparison of conventional pain coping skills training and pain coping skills training with a maintenance training component: a daily diary analysis of short- and long-term treatment effects. J Pain 7:615-25
Keefe, F J; Lefebvre, J C; Kerns, R D et al. (2000) Understanding the adoption of arthritis self-management: stages of change profiles among arthritis patients. Pain 87:303-13
Lefebvre, J C; Keefe, F J; Affleck, G et al. (1999) The relationship of arthritis self-efficacy to daily pain, daily mood, and daily pain coping in rheumatoid arthritis patients. Pain 80:425-35
Affleck, G; Tennen, H; Keefe, F J et al. (1999) Everyday life with osteoarthritis or rheumatoid arthritis: independent effects of disease and gender on daily pain, mood, and coping. Pain 83:601-9
Keefe, F J; Bonk, V (1999) Psychosocial assessment of pain in patients having rheumatic diseases. Rheum Dis Clin North Am 25:81-103
Keefe, F J; Lefebvre, J C; Maixner, W et al. (1997) Self-efficacy for arthritis pain: relationship to perception of thermal laboratory pain stimuli. Arthritis Care Res 10:177-84
Keefe, F J; Affleck, G; Lefebvre, J C et al. (1997) Pain coping strategies and coping efficacy in rheumatoid arthritis: a daily process analysis. Pain 69:35-42
Keefe, F J; Caldwell, D S (1997) Cognitive behavioral control of arthritis pain. Med Clin North Am 81:277-90

Showing the most recent 10 out of 11 publications