Persistent pain is a significant problem for many non-cardiac chest pain patients. Although coping skills training (CST) methods have only recently been applied to the management of non-cardiac chest pain, these methods appear to be promising. After completing CST, many patients report significant reductions in pain and improvements in physical and psychosocial disability. Data from follow-up studies, however, indicate that while some patients are able to maintain treatment gains in pain, others are not. Given the advantages of CST (its low cost and minimal side effects) and its demonstrated promise, there is a need to explore new ways to help non-cardiac chest pain patients maintain and extend their initial treatment gains. The proposed study seeks to determine whether the effects of CST can be enhanced by combing it with Sertraline-a psychotropic medication that we have recently found in preliminary research can significantly decrease pain in non-cardiac chest pain patients. In the proposed study, 200 non-cardiac chest pain patients will be randomly assigned to four conditions: a) CST plus Sertraline, b) CST plus placebo, c) Sertraline alone, and d) Placebo alone. Outcome measures will be collected before and after the 10 week treatment phase of the study and at 6-months post-treatment. The study: 1) will evaluate whether a protocol that combines CST with Sertaline helps patients maintain gains in pain, physical disability, psycholosocial disability, and 2) will determine how changes in patients' pain-related catastrophizing and daily use of coping skills relate to long-term (6 months) improvements in pain and disability. If CST plus Sertraline is effective, future studies could evaluate the efficacy of this biobehavioral protocol for other populations having persistent pain (e.g. osteoarthritis, sickle cell disease, or cancer). Future studies could also identify the particular components of CST (e.g. training in attention diversion methods, behavioral coping strategies, or cognitive restructuring) 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 non-cardiac chest pain patients. The study proposed rigorously evaluates methods for enhancing the effects of coping skills training and Sertraline in non-cardiac chest pain patients. This study may lead to major advances in our understanding of non-cardiac chest pain and enlarge our repertoire of methods for effectively treating non-cardiac chest pain.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH063429-03
Application #
6639243
Study Section
Special Emphasis Panel (ZRG1-RPHB-3 (01))
Program Officer
Muehrer, Peter R
Project Start
2001-04-01
Project End
2006-03-31
Budget Start
2003-04-01
Budget End
2004-03-31
Support Year
3
Fiscal Year
2003
Total Cost
$534,734
Indirect Cost
Name
Duke University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
044387793
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
Keefe, Francis J; Shelby, Rebecca A; Somers, Tamara J et al. (2011) Effects of coping skills training and sertraline in patients with non-cardiac chest pain: a randomized controlled study. Pain 152:730-41
Shelby, Rebecca A; Somers, Tamara J; Keefe, Francis J et al. (2009) Pain catastrophizing in patients with noncardiac chest pain: relationships with pain, anxiety, and disability. Psychosom Med 71:861-8
Malenbaum, Sara; Keefe, Francis J; Williams, Amanda C de C et al. (2008) Pain in its environmental context: implications for designing environments to enhance pain control. Pain 134:241-4
Porter, Laura S; Davis, Deborah; Keefe, Francis J (2007) Attachment and pain: recent findings and future directions. Pain 128:195-8
Applegate, Katherine L; Keefe, Francis J; Siegler, Ilene C et al. (2005) Does personality at college entry predict number of reported pain conditions at mid-life? A longitudinal study. J Pain 6:92-7
Keefe, Francis J; Abernethy, Amy P; C Campbell, Lisa (2005) Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol 56:601-30
McCracken, Lance M; Carson, James W; Eccleston, Christopher et al. (2004) Acceptance and change in the context of chronic pain. Pain 109:4-7
Keefe, Francis J; Rumble, Meredith E; Scipio, Cindy D et al. (2004) Psychological aspects of persistent pain: current state of the science. J Pain 5:195-211
Campbell, Lisa C; Clauw, Daniel J; Keefe, Francis J (2003) Persistent pain and depression: a biopsychosocial perspective. Biol Psychiatry 54:399-409

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