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.
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