Coping Strategies for Chronic Pain

No longer 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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether positive coping statements can reduce cravings for prescription opioids in people with chronic pain. Researchers are testing if changing thoughts about pain can decrease cravings for these medications. Participants will practice daily pain coping statements for a week. This trial suits those who have used prescription opioids for over three months to manage chronic pain. As an unphased trial, it offers a unique opportunity to contribute to innovative research that could improve pain management strategies.

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 prior data suggests that this coping strategy is safe for managing chronic pain?

Research has shown that cognitive-behavioral therapy (CBT), which employs methods like coping statements, is generally safe and well-tolerated. Studies have found that CBT can help individuals with chronic pain by reducing pain levels and improving pain management. It often leads to positive outcomes without major side effects.

A review of several studies found that changing thoughts about pain, a key component of CBT, can lessen the perceived intensity of pain. Another study demonstrated that learning coping skills can improve pain management and reduce the need for pain medication.

Overall, these findings suggest that using coping statements as part of CBT is a safe method for managing chronic pain and related challenges. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores the power of mental strategies—specifically, coping statements—in managing chronic pain. Unlike standard treatments that often rely on medications like opioids or NSAIDs, this approach empowers patients to use their own thoughts and words to influence their perception of pain. This method is drug-free and can be practiced anywhere, offering a potentially safer and more accessible way to help alleviate chronic pain. Researchers hope to uncover whether these daily affirmations can significantly reduce pain perception and improve quality of life for those affected.

What evidence suggests that coping statements could be effective for reducing opioid craving in chronic pain patients?

Research has shown that cognitive-behavioral therapy (CBT) can assist individuals with long-term pain. Studies find that CBT reduces depression, anxiety, and stress, which often accompany pain. Improved pain management typically leads to better treatment outcomes. CBT works by altering negative thoughts and behaviors that can exacerbate pain. In this trial, participants in the experimental arm will practice positive coping statements daily for 7 days, which might yield similar benefits, potentially reducing the desire for opioids related to pain. These findings suggest that focusing on coping strategies can play a crucial role in managing chronic pain. ^{1 2 6 7 8}

Who Is on the Research Team?

Dokyoung S You, PhD

Principal Investigator

Stanford University

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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]

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]

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]

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]

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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5999451/

Cognitive-behavioral therapy for patients with chronic pain Previous studies have shown that CBT is effective for depression, anxiety, stress, and chronic pain. Additionally, CBT has been reported to ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8489050/

Cognitive–behavioral therapy for management of mental ... Cognitive–behavioral therapy (CBT) helps individuals to eliminate avoidant and safety-seeking behaviors that prevent self-correction of faulty beliefs.

3. sciencedirect.com sciencedirect.com/science/article/pii/S0022399923000648

Improvements in pain coping predict treatment success ... Patients' symptoms, cognitive and behavioral pain coping improved significantly after treatment. Similarly, separate cognitive and behaviroal coping skills ...

4. frontiersin.org frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2023.1200685/full

A systematic review of cognitive behavioral therapy-based ... Traditional CBT has beneficial effects in adults with chronic pain (Williams et al., 2020) and is also effective in patients with emotional ...

5. va.gov va.gov/painmanagement/docs/cbt-cp_therapist_manual.pdf

Cognitive Behavioral Therapy for Chronic Pain Program evaluation results indicate that the training in and implementation of these therapies have significantly enhanced therapist skills and Veteran outcomes ...

6. sciencedirect.com sciencedirect.com/science/article/pii/S0022399924002496

A meta-analysis of cognitive restructuring in chronically ill ... This meta-analysis synthesizes research on the impact of cognitive restructuring on chronic pain intensity, aiming to integrate diverse methodologies and ...

7. jpsmjournal.com jpsmjournal.com/article/S0885-3924(23)00445-1/fulltext

Effect of Pain Coping Skills Training on ... Both conditions led to improvements in pain, pain medication use, pain self-efficacy, and coping skills use, and 5-session PCST showed the greatest benefits.

8. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2832235

Mindfulness vs Cognitive Behavioral Therapy for Chronic ... Results of the study suggest that both treatments have potential utility in treating adults with refractory CLBP and improving pain, function, and quality-of- ...