The proposed study uses stress management training, deep muscle relaxation, and self-directed imagery procedures to help elderly people cope with chronic pain resulting from osteoarthritis. The project has three objectives: (1) To assess the effectiveness of these therapeutic interventions. (2) To assess changes in subjects' medical status, pain experiences, pain and sensory thresholds, functional levels, coping skills, activities, and use of analgesic drugs. (3) To identify personality variables that covary with treatment or predict the effectiveness of the interventions. The interventions will be administered by paraprofessionals (advanced undergraduates or graduates trained and supervised by the investigators) in a community based setting (the subjects' homes or at the local Commission on Aging Center). The therapeutic intervention will be administered over a two month period of time. It will be followed by a three month maintenance procedure designed to facilitate transfer of the pain management techniques from the therapist's control to the subject's control, and a two month follow up period during which the subjects' progress will be monitored. Assessments will be administered prior to and after the main intervention, after the maintenance procedure, and during the follow up period. The subject population will be 60 elderly persons with osteoarthritis. Thirty subjects will comprise the experimental group and 30 subjects the control group. The proposed research employs interventions commonly used in behavioral medicine; however, it is significant in that the body of research on chronic pain is perceived to be fraught with various methodological weaknesses - preliminary studies, single-case and small-group designs, lack of control groups. Also, relatively few studies in the chronic pain literature have been conducted with elderly people. The study will also explore the relationship between pain and psychological variables which may influence the severity of pain experiences. It will examine coping skills and ability to maintain self-control, variables which are believed to influence health and well-being - particularly in the elderly. Finally, the study is significant because it examines an alternative to analgesic drug use for the elderly.
