Chronic pain is a significant problem for many osteoarthritis patients. The ultimate goal of this research is to develop better ways to evaluate and treat this pain. Our preliminary research revealed that pain coping strategies can be reliably assessed using a questionnaire developed in our laboratory. A Pain Control and Rational Thinking factor identified through factor analysis of questionnnaire responses explain a significant proportion of variance in pain, physical disability, and psychological disability. This factor was a much stronger predictor of pain and functional impairment than x-ray ratings of disease severity, obesity status, or age. The proposed study examines whether a cognitive- behavioral intervention designed to improve patients' pain coping skills and increase their scores on the Pain Control and Rational Thinking factor will improve patients' pain and functional status. One hundred and fifty patients having chronic knee pain and radiographic evidence of osteoarthritis of the knees will be randomly assigned to three conditions: pain coping skill training, arthritis education, or standard care. Subjects in the pain coping skills condition will attend 10 weekly group sessions training them to recognize and reduce irrational cognitions and use attention diversion and changes in activity patterns to control and decrease pain. Arthritis education subjects will attend 10 weekly group sessions providing them with detailed information on osteoarthritis. Standard care subjects will receive the standard care provided to osteoarthritic knee pain patients. Data will be analyzed in order to: 1) compare the efficacy of pain coping skills training to arthritis education and standard care control on both a short-term (10 week) and long-term (6 months) basis, and 2) analyze the relationship of changes in pain coping strategies to improvements in pain and function. The longterm benefit of this research is that it may provide osteoarthritis patients with more effective means of coping with a chronic and often progressive disease. If the cognitive-behavioral intervention is effective, it could be applied in future studies to osteoarthritis patients having pain in other major joints such as the hip. Programmatic research also could be carried out to identify the elements of the intervention that contribute most to treatment effects. By isolating active ingredients, one could streamline treatment, making it more cost effective and thus more readily available to the large population of individuals having osteoarthritic pain.
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