Coping Strategies for Chronic Pain

Recruiting at 1 trial location

Overseen By Tara Maronesy, BS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Stanford University

Must be taking: Opioids

Disqualifiers: Cancer, Severe psychiatric conditions, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

97 Participants Needed

Trial Summary

Do I have to stop taking my current medications for this trial?

The trial does not specify if you need to stop taking your current medications. However, since the study involves opioid use, you may need to continue your prescription opioids as part of the trial.

What data supports the idea that Coping Strategies for Chronic Pain is an effective treatment?

The available research shows that Coping Strategies for Chronic Pain, like Cognitive Behavioral Therapy (CBT), are effective in improving pain and related problems for people with chronic pain. Multiple studies have shown that CBT helps people manage their pain better, and it has been beneficial for different groups, including children and older adults. Additionally, CBT has been adapted to be delivered in various ways, such as online or over the phone, making it more accessible. Compared to other treatments, CBT is supported by evidence from many trials, showing it can improve how people function and reduce their need for healthcare. ^{1 2 3 4 5}

What safety data exists for CBT in treating chronic pain?

Cognitive behavioral therapy (CBT) for chronic pain is considered a safe and effective treatment alternative to opioid analgesics. Multiple studies, including randomized controlled trials, support its efficacy and safety across various chronic pain conditions and populations, such as children and older adults. Innovations in delivery methods, like internet-based CBT, have also been explored to improve access and maintain safety. ^{1 4 6 7 8}

Is the treatment in the trial 'Coping Strategies for Chronic Pain' a promising treatment?

Yes, coping strategies are promising for managing chronic pain. They help people handle pain by using different methods like cognitive (thinking), behavioral (actions), and social (interactions) strategies. These strategies can improve how people function and feel, making them a valuable approach for those dealing with chronic pain. ^{1 2 3 9 10}

What is the purpose of this trial?

Adherence to prescription opioid and opioid tapering as indicated are critical for safe chronic opioid therapy for chronic pain, but this can be difficult for patients experiencing prescription opioid craving. Because pain catastrophizing is proposed as a possible treatment target by our and others' preliminary results, the proposed study aims to determine whether pain catastrophizing is a treatment target to reduce prescription opioid craving and to investigate whether negative affect and stress hormones are potential mediators. The findings from the current study will inform whether a psychology intervention to lower pain catastrophizing will reduce opioid craving, and whether psychological and physical distress as well as cognitive function will be potential mediators of the treatment effect.

Research Team

Dokyoung S You, PhD

Principal Investigator

Stanford University

Eligibility Criteria

This trial is for adults over 18 with chronic pain lasting more than 3 months who have been using prescription opioids. Participants must speak English and have access to email or a smartphone. People with cancer, severe psychiatric conditions, concurrent psychological therapy, skin conditions on the hand, or without technology access cannot join.

Inclusion Criteria

I have been using prescribed opioids for more than 3 months.

I have been experiencing pain for more than 3 months.

Exclusion Criteria

No access to email or smart phone

I do not have severe psychiatric conditions like schizophrenia or active thoughts of suicide.

I have a skin condition on my hand.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants practice pain coping statements daily for 7 days to reduce pain catastrophizing

1 week

Daily self-administered intervention

Monitoring

Participants' opioid craving, opioid use, and negative affect are monitored daily

2 weeks

Daily self-reporting

Follow-up

Participants are monitored for safety and effectiveness after intervention

2 weeks

Treatment Details

Interventions

• Coping Statement

Trial Overview The study tests if 'pain catastrophizing'—a negative mental approach to pain—can be reduced to lessen opioid craving in chronic pain patients. It will also explore if stress hormones and negative emotions are part of why this might work.

Participant Groups

Group I: Coping statement Experimental Treatment 1 Intervention

Daily practice of pain coping statements for 7 days

Group II: Control Active Control 1 Intervention

No instruction about pain coping statement.

Who Is Running the Clinical Trial?

Stanford University

Lead Sponsor

Trials

2,527

Recruited

17,430,000+

National Institute on Drug Abuse (NIDA)

Collaborator

Trials

2,658

Recruited

3,409,000+

Findings from Research

Cognitive-behavioral therapy (CBT) is an effective first-line treatment for chronic pain, supported by numerous randomized controlled trials showing improvements in pain and related issues across various chronic pain syndromes.

Recent innovations in CBT delivery, such as web-based and telephone formats, have expanded its accessibility and effectiveness for diverse populations, including children and older adults, indicating a promising direction for future treatment approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Ehde, DM., Dillworth, TM., Turner, JA.[2022]

Coping with chronic pain involves multiple dimensions of functioning, including cognitive, emotional, behavioral, and physiological aspects, highlighting the complexity of pain management.

The review discusses various coping strategies, such as religious, social, and psychological methods, and emphasizes the need for interventions that enhance these coping mechanisms to improve patients' overall quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping strategies in chronic pain. Peres, MF., Lucchetti, G.[2022]

The development of an abbreviated 42-item version of the Chronic Pain Coping Inventory (CPCI) shows very high correlations with the original 65-item version, indicating it effectively measures coping strategies in chronic pain patients.

The abbreviated CPCI maintains comparable reliability, internal consistency, and validity, making it a suitable alternative for situations where a shorter assessment is needed without losing accuracy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Chronic Pain Coping Inventory-42: reliability and validity. Romano, JM., Jensen, MP., Turner, JA.[2019]

A survey of 152 physical therapists revealed that while only a minority currently use cognitive-behavioral therapy (CBT) techniques like activity pacing (81%) and pleasurable activity scheduling (30%) for treating older patients with chronic pain, there is a significant interest in incorporating these methods into practice.

Barriers to using CBT include a lack of knowledge and skills, concerns about reimbursement, and time constraints, indicating that addressing these issues could enhance the integration of CBT into physical therapy for chronic pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical therapists' use of cognitive-behavioral therapy for older adults with chronic pain: a nationwide survey. Beissner, K., Henderson, CR., Papaleontiou, M., et al.[2021]

In a study of 94 chronic pain patients, improvements in physical and psychological functioning after inpatient pain treatment were linked to changes in patients' pain beliefs and cognitive coping strategies over a period of 3 to 6 months.

While some coping strategies, like exercise, contributed to better outcomes, others, such as resting, did not show a significant association with improvement, highlighting the importance of specific coping methods in pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Correlates of improvement in multidisciplinary treatment of chronic pain. Jensen, MP., Turner, JA., Romano, JM.[2019]

A study involving 278 patients with chronic back pain found that an AI-driven cognitive behavioral therapy for chronic pain (AI-CBT-CP) was noninferior to standard telephone CBT-CP, showing similar effectiveness in reducing disability and pain over 6 months.

AI-CBT-CP not only achieved better clinical outcomes for patients but also required less than half the therapist time compared to traditional CBT-CP, suggesting it could improve access to treatment for more patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: A Randomized Comparative Effectiveness Trial. Piette, JD., Newman, S., Krein, SL., et al.[2023]

A single-session videoconference intervention called empowered relief (ER) significantly reduced pain catastrophizing and improved pain-related outcomes in adults with chronic pain, showing substantial clinical importance at 3 months post-treatment.

Participants reported high satisfaction and engagement with the ER program, suggesting that web-based delivery can enhance accessibility and address barriers to in-person pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of a Single-Session "Empowered Relief" Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic. Ziadni, MS., Gonzalez-Castro, L., Anderson, S., et al.[2022]

Guided internet-based cognitive-behavioral therapy (iCBT) has been shown to be effective for chronic pain management, outperforming both passive and active control conditions in improving psychological, physical, and daily life outcomes across 33 studies with 5133 participants.

The treatment was generally safe with high satisfaction rates and minor adverse events, although dropout rates were influenced by factors like time commitment and technical issues, suggesting that optimizing delivery methods could enhance patient retention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guided internet-based cognitive-behavioral therapy for patients with chronic pain: A meta-analytic review. Terpstra, JA., van der Vaart, R., van Beugen, S., et al.[2022]

In a study of 230 patients seeking pain management, acceptance of pain was found to be a stronger predictor of reduced distress and disability compared to traditional coping strategies.

The findings suggest that shifting the focus from controlling pain to accepting it may improve patient functioning and overall quality of life in chronic pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of the relative utility of coping and acceptance-based measures in a sample of chronic pain sufferers. McCracken, LM., Eccleston, C.[2022]

The Turkish version of the Coping Strategies Questionnaire (CSQ-T) has been validated and shown to be reliable for assessing chronic musculoskeletal pain in a study of 123 patients, with high reliability scores (Cronbach's alpha between 0.814 and 0.934).

The CSQ-T demonstrated good construct validity, correlating significantly with the Hospital Anxiety and Depression Scale and the Short Form-36 health survey, indicating it effectively measures coping strategies related to pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Coping Strategies Questionnaire: Translation, cultural adaptation, reliability and validity in Turkish-speaking patients with chronic musculoskeletal pain. Sozlu, U., Hazar Kanik, Z., Gunaydin, G., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Coping strategies in chronic pain. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

The Chronic Pain Coping Inventory-42: reliability and validity. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Physical therapists' use of cognitive-behavioral therapy for older adults with chronic pain: a nationwide survey. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Correlates of improvement in multidisciplinary treatment of chronic pain. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: A Randomized Comparative Effectiveness Trial. [2023]

7. Canada pubmed.ncbi.nlm.nih.gov

Efficacy of a Single-Session "Empowered Relief" Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic. [2022]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Guided internet-based cognitive-behavioral therapy for patients with chronic pain: A meta-analytic review. [2022]

9. England pubmed.ncbi.nlm.nih.gov

A comparison of the relative utility of coping and acceptance-based measures in a sample of chronic pain sufferers. [2022]

10. England pubmed.ncbi.nlm.nih.gov

The Coping Strategies Questionnaire: Translation, cultural adaptation, reliability and validity in Turkish-speaking patients with chronic musculoskeletal pain. [2022]