The overall objective of the study is to increase our understanding of whether and how a cognitive therapy intervention reduces pain and pain-related dysfunction in persons with chronic pain secondary to a disability. Specifically, the project will: (1) evaluate the efficacy of a telephone-delivered cognitive therapy intervention for pain in a sample of adults with chronic pain and acquired amputation, multiple sclerosis, or spinal cord injury via a randomized clinical trial;and (2) study the potential mechanisms of the effects of cognitive therapy by determining whether treatment-related changes in cognitions (specifically catastrophizing cognitions and control beliefs) mediate the effects of the intervention on pain.
These aims will be accomplished by randomly assigning persons with disabilities and chronic pain (N = 160) to one of two conditions. In the first condition, the telephone-delivered cognitive therapy condition, participants will received cognitive therapy specifically instructing them in cognitive strategies (e.g., recognition of maladaptive thinking, cognitive restructuring, thought stopping) targeting pain catastrophizing, control beliefs, and other negative thoughts about pain. The intervention will be provided over the telephone to mitigate access barriers to treatment faced by many persons with pain and disability. The second condition will be a telephone-delivered pain education condition in which participants will receive education about chronic pain, but no instruction in cognitive or behavioral pain management strategies;the second condition will thus serve as an attention control condition. If the study hypotheses are supported, and the telephone-delivered cognitive therapy condition is shown to be efficacious in reducing pain and improving functioning relative to the education condition, the intervention used in this proposal will serve as a basis for a telephone-delivered treatment that could stand alone or be incorporated into interdisciplinary biopsychosocial interventions for pain in persons with disabilities. These findings will also advance the field of pain treatments by furthering our theoretical understanding of hypothesized, but rarely tested, mechanisms thought to underlie the efficacy of cognitive therapy for chronic pain. A compelling argument for the proposed study is to address the lack of clinical trials aimed at treating chronic pain in persons with disabilities;despite its high prevalence, the chronic pain problems experienced by persons with disabilities are not being adequately addressed. Given pain itself can be quite disabling, chronic pain as a secondary condition has the potential to contribute to disability and poor quality of life over and above the effects of the primary disability itself (Dworkin, 1997;Fordyce, 1976). The proposed study recognizes the importance of including persons with pain secondary to a disability in the study and treatment of chronic pain and acknowledges the need for developing effective treatments that are accessible yet low cost.
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