Chronic low back pain (CLBP) is a major source of disability for more than 5 million Americans. Estimates of the economic impact range from $50 to $100 billion annually. The magnitude of psychological distress and disability in these patients is immeasurable. Spinal cord stimulator (SCS) implantation surgery represents an important advance in the treatment of patients suffering from CLBP. SCS implants are becoming increasingly common, with tens of thousands of SCSs implanted annually. Unfortunately, the success rate of SCS implantation varies widely, and most patients will continue to experience some degree of pain following the procedure. Clinical observations suggest that the ability of patients to cope with this pain is quite varied. The proposed study seeks to determine whether a perioperative pain coping skills training protocol will lead to improvements in pain coping and self efficacy for pain management and to reductions in physical disability, psychological distress, pain and pain behavior in patients having CLBP who undergo SCS surgery. In this study, 128 patients who are undergoing SCS implant will be randomly assigned to one of three conditions: 1) Pain coping skills training for implant surgery (PCST-IS) which systematically trains patients in a variety of cognitive and behavioral coping skills designed to increase their self efficacy with regard to their abilities to address specific challenges posed by SCS implant surgery; 2) Chronic pain education a comparison condition providing education on the nature and treatment of chronic low back pain; or, 3) standard care control condition. Assessment measures to be collected before and after treatment and at 6 and 12 months follow up include measures of self efficacy, pain coping, physical disability, psychological distress, pain, and pain behavior. If peri surgical pain coping skills training is effective, it would lay important groundwork for further application and testing of this treatment in other pain related surgical interventions. An evidence based psychological intervention could have significant implications for the medical management of spinal cord stimulator patients. It also could lead to a greater integration of psychological interventions into standard medical care for patients undergoing surgery for a number of other painful conditions. As a result, this research ultimately could lead to peri surgical coping skills interventions that could improve the physical and psychological functioning of patients suffering from a variety of pain related conditions. Public Health Relevance: The ultimate goal of this research is to find ways to enhance outcomes for patients with chronic low back pain who are receiving spinal cord stimulator implants. This study will test whether peri operative pain coping skills training is effective in increasing patients' pain coping and their self confidence for managing pain and decreasing patients' physical disability, psychological distress, pain, and pain behaviors. If successful, this research could have important implications for the medical management of spinal cord stimulator patients, and could also lead to peri surgical coping skills interventions to improve outcomes for patients suffering from a variety of pain related conditions. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
1R01NS053759-01A2
Application #
7524810
Study Section
Special Emphasis Panel (ZRG1-RPHB-B (05))
Program Officer
Porter, Linda L
Project Start
2008-09-30
Project End
2012-08-31
Budget Start
2008-09-30
Budget End
2009-08-31
Support Year
1
Fiscal Year
2008
Total Cost
$433,284
Indirect Cost
Name
Duke University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Keefe, F J; Porter, L; Somers, T et al. (2013) Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. Br J Anaesth 111:89-94
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
Keefe, Francis J; Wren, Anava A (2013) Optimism and pain: a positive move forward. Pain 154:7-8
Keefe, Francis J; Huling, Dane A; Coggins, Michael J et al. (2012) Virtual reality for persistent pain: a new direction for behavioral pain management. Pain 153:2163-6
Abernethy, Amy P; Wheeler, Jane L; Courtney, Paul K et al. (2011) Supporting implementation of evidence-based behavioral interventions: the role of data liquidity in facilitating translational behavioral medicine. Transl Behav Med 1:45-52
Keefe, Francis J (2011) Behavioral medicine: a voyage to the future. Ann Behav Med 41:141-51
Lumley, Mark A; Cohen, Jay L; Borszcz, George S et al. (2011) Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol 67:942-68
Wren, Anava A; Wright, Melissa A; Carson, James W et al. (2011) Yoga for persistent pain: new findings and directions for an ancient practice. Pain 152:477-80