Although there is growing empirical evidence that cognitive behavior therapy aimed at improving coping skills is beneficial for individuals who suffer from chronic pain, access to these interventions is often limited. Chronic pain is highly prevalent in OEF/OIF veterans. The primary aim of this study will be to test the effectiveness of telephone- delivered cognitive-behavior therapy in the management of chronic pain among post- deployment veterans with chronic pain. A secondary aim will be to determine mechanisms by which this intervention facilitates pain management and successful adjustment of OEF/OIF veterans to chronic pain. The major hypothesis is that patients who receive telephone-delivered cognitive-behavior therapy will show significant improvements in pain-related coping skills, reduced emotional distress, and increased quality of life compared with those who receive telephone-delivered pain education. To achieve these aims, a two-arm randomized clinical trial will be conducted with 150 individuals who suffer from chronic pain, recruited from primary care clinics at the VA Medical Center in San Francisco and affiliated VA Community-based Outpatient Clinics in San Bruno, Santa Rosa, Ukiah, and Eureka. Currently enrolled patients with pain disorders involving muscle strain and inflammation, trauma to nerves, or central nervous system dysfunction will be invited to participate. In Study Arm 1, patients will receive telephone-delivered cognitive behavior therapy (T-CBT);and in Study Arm 2, patients will receive telephone-delivered pain education (T-EDU) matched with Study Arm 1 for amount of contact time. Patients in both groups will receive 12 sessions of telephone- delivered individual therapy over a 20-week period. Pain management outcomes will be measured at 10 weeks (mid-treatment), 20 weeks (post-treatment), 32 weeks (3-month follow-up), and 46 weeks (6-month follow-up). Outcome variables will include measures of pain symptoms, level of functioning, coping, and emotional distress. The sample size will provide greater than 80% power to detect significant differences between groups, at a two-tailed alpha of 0.05. The study hypothesis, assessment methodology, and intervention procedures are based on the cognitive-behavioral model of chronic pain.
Chronic pain represents an epidemic in the United States and a serious public health problem. Pain has been identified as one of the most frequent presenting complaints in VHA primary care settings. In the VHA, approximately 50% of veterans seen in primary care settings report chronic pain. Chronic pain is highly prevalent among OEF/OIF veterans. Although psychological interventions aimed at improving coping skills are now commonly used within interdisciplinary pain management programs, access to these programs is often limited due to the distance from clinical care and disabling impact of pain disorders. In addition, the dropout rate in studies of face-to-face cognitive behavior therapy for chronic pain is problematic. If the hypotheses are supported, the VA will have a validated psychosocial treatment for chronic pain in primary care settings at Community Based Outpatient Clinics (CBOCs).
