Gratitude Exercises for Acute Pain

Overseen By Ashley Pfeiffer, DPT

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Black Hills State University

Must not be taking: Opioids

Disqualifiers: Cardiovascular, Epilepsy, Diabetes, Pregnancy, others

Compensation: Varies

Number of Visits: 2

150 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this clinical trial is to compare the effects of a brief gratitude intervention on individuals' psychological and physiological responses to acute pain. Furthermore, these associations will be examined in the context of genetic variations associated with both pain and psychological processes.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are currently taking opioids.

What data supports the effectiveness of the treatment Behavioral Writing Intervention, Expressive Writing, Therapeutic Writing for acute pain?

Research on behavioral approaches to pain management, including writing interventions, suggests they can help improve emotional and physical functioning by changing how people respond to pain, even if the pain itself doesn't decrease. This aligns with findings that behavioral treatments can be effective for chronic pain, indicating potential benefits for acute pain as well. ^{1 2 3 4 5}

Is it safe to participate in a clinical trial involving gratitude exercises for acute pain?

Behavioral treatments, including writing exercises, are generally considered safe and may help people lead more normal and productive lives, although more research is needed to confirm their effectiveness. ^{6 7 8 9 10}

How is the Behavioral Writing Intervention treatment different from other treatments for acute pain?

The Behavioral Writing Intervention, also known as Expressive Writing or Therapeutic Writing, is unique because it focuses on using writing exercises to express emotions and thoughts, which can help manage pain by promoting positive emotions and psychological flexibility. Unlike traditional pain treatments that may focus on medication or physical therapies, this approach leverages the therapeutic benefits of writing to improve emotional well-being and resilience. ^{11 12 13 14 15}

Research Team

Nathan Deichert, PhD

Principal Investigator

Black Hills State University

Eligibility Criteria

This trial is for adults who are currently pain-free and at least 18 years old. It's designed to explore how a positive mindset, specifically gratitude, can affect the way people experience pain.

Inclusion Criteria

I do not experience any pain.

I am 18 years old or older.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Intervention

Participants are randomized to a gratitude or neutral writing condition and complete a cold pressor task

1 day

1 visit (in-person)

Follow-up

Participants are monitored for psychological and physiological responses immediately after the intervention

10 minutes

1 visit (in-person)

Treatment Details

Interventions

• Behavioral Writing Intervention

Trial Overview The study tests a behavioral writing intervention that encourages gratitude to see if it changes psychological and physiological reactions to acute pain. The trial will also look into how genetic differences might influence these effects.

Participant Groups

Group I: Gratitude Writing Experimental Treatment 1 Intervention

In the gratitude writing condition, participants will write continuously for 5 minutes about someone they are grateful for.

Group II: Neutral Writing Placebo Group 1 Intervention

Participants in the neutral writing condition will write continuously for 5 minutes about how they got to the research laboratory.

Who Is Running the Clinical Trial?

Black Hills State University

Lead Sponsor

Trials

5

Recruited

400+

National Institute of General Medical Sciences (NIGMS)

Collaborator

Trials

315

Recruited

251,000+

Findings from Research

Recent research emphasizes the importance of behavioral and cognitive-behavioral approaches in managing chronic pain, highlighting their effectiveness in addressing the social context and psychological factors related to pain.

Studies show that these approaches can lead to significant improvements in pain management outcomes compared to control conditions, suggesting they are a valuable part of chronic pain treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral and cognitive-behavioral approaches to chronic pain: recent advances and future directions. Keefe, FJ., Dunsmore, J., Burnett, R.[2019]

In a study of 174 patients undergoing acceptance and commitment therapy for chronic pain, improvements in physical and emotional functioning were observed even when pain intensity and distress did not significantly decrease during treatment.

The findings suggest that changing responses to pain, rather than reducing pain itself, may be key to enhancing functioning, indicating a shift in how chronic pain treatment can be approached.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Are reductions in pain intensity and pain-related distress necessary? An analysis of within-treatment change trajectories in relation to improved functioning following interdisciplinary acceptance and commitment therapy for adults with chronic pain. Vowles, KE., Witkiewitz, K., Levell, J., et al.[2022]

The biopsychosocial model emphasizes that pain is influenced by biological, psychological, and social factors, making it essential to use multifaceted evidence-based outcomes to assess treatment efficacy.

Two main categories of outcomes for pain management are identified: patient-reported outcomes, which include pain levels and quality of life, and objective outcomes, which focus on healthcare utilization and occupational status, both of which align with current evidence-based guidelines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evidence-based outcomes in pain research and clinical practice. Gatchel, RJ., Theodore, BR.[2019]

Patients referred for pain management from Disability showed less improvement in pain, mood, and control compared to those referred from Medical Subspecialties, indicating a potential difference in treatment response based on referral source.

Patients from the Disability group not only improved less but also had longer hospital stays and lower compliance with treatment, suggesting that factors related to their referral may influence the effectiveness of behavioral pain management approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral treatment of chronic pain: variables affecting treatment efficacy. Block, AR., Kremer, E., Gaylor, M.[2021]

In a study involving 149 patients in a 15-day chronic pain management program, Goal Attainment Scaling (GAS) demonstrated significant improvements, indicating its effectiveness as a therapeutic tool for achieving personalized goals in rehabilitation.

Patients maintained their improvements in GAS and other measures like pain intensity and disability at a six-month follow-up, suggesting that GAS is a valid and reliable outcome measure for assessing long-term benefits of rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Goal attainment scaling in evaluating a multidisciplinary pain management programme. Fisher, K., Hardie, RJ.[2017]

Behavioral treatments for chronic benign pain, including operant, relaxation, cognitive, and multimodal approaches, show positive outcomes, but the overall quality of the studies is poor, making it difficult to conclusively determine their effectiveness.

The operant method is associated with increased activity and reduced pain and medication use, while relaxation techniques can lower muscle tension and pain; however, more rigorous research is needed to establish the efficacy of these treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A critical review of behavioural treatments for chronic benign pain other than headache. Linton, SJ.[2019]

In a pilot study involving 30 children aged 7 to 18 undergoing painful medical procedures, 83% of participants found the BrightHearts biofeedback app helpful and expressed a willingness to use it again, indicating strong acceptability.

Healthcare professionals also reported that BrightHearts facilitated the procedures, with 64% believing it made the process easier, suggesting potential benefits for both patients and providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Feasibility of Using the BrightHearts Biofeedback-Assisted Relaxation Application for the Management of Pediatric Procedural Pain: A Pilot Study. Burton, KLO., Morrow, AM., Beswick, BV., et al.[2019]

Understanding pain as a protective function can help in developing strategies for recovery, emphasizing the importance of cognitive, emotional, and behavioral responses to pain.

The proposed framework using Cognitive Functional Therapy focuses on safety learning and experiential learning to help individuals regain control over their pain and improve their quality of life, addressing the psychological aspects of pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

From Fear to Safety: A Roadmap to Recovery From Musculoskeletal Pain. Caneiro, JP., Smith, A., Bunzli, S., et al.[2022]

Chronic postsurgical pain (CPSP) is influenced by psychological factors, with negative emotions like anxiety and depression identified as significant risk factors, while protective factors are less studied.

The Acceptance and Commitment Therapy (ACT) approach used in the Transitional Pain Service at Toronto General Hospital shows promise in reducing pain and opioid use, with patients receiving this intervention reporting greater improvements in pain management and lower depression scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. Weinrib, AZ., Azam, MA., Birnie, KA., et al.[2020]

The study developed and validated three scales for measuring negative responses to pain (BIS-related) and two scales for positive responses (BAS-related) in a sample of 395 undergraduates, including 325 with recurrent pain.

The results support the Behavioral Inhibition System-Behavioral Activation System (BIS-BAS) model, showing that the scales are reliable and valid for assessing pain responses, although the positive response scales showed less stability over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Measuring the Cognitions, Emotions, and Motivation Associated With Avoidance Behaviors in the Context of Pain: Preliminary Development of the Negative Responsivity to Pain Scales. Jensen, MP., Ward, LC., Thorn, BE., et al.[2018]

In a study involving three adolescents with chronic debilitating pain, Acceptance and Commitment Therapy (ACT) led to an increase in participation in valued activities, even though pain intensity did not decrease during the treatment period.

The findings suggest that while ACT can enhance engagement in meaningful activities for youth with chronic pain, it may not necessarily reduce pain levels, indicating a need for further research on how ACT facilitates change in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring Changes in Valued Action in the Presence of Chronic Debilitating Pain in Acceptance and Commitment Therapy for Youth - A Single-Subject Design Study. Kemani, MK., Olsson, GL., Holmström, L., et al.[2020]

In a study involving 108 participants with chronic pain due to spinal cord injury, those who practiced positive psychology exercises for 8 weeks reported significant reductions in pain intensity and improvements in pain management compared to baseline.

The benefits of these exercises were maintained at a 3-month follow-up, suggesting that positive psychology can be an effective complementary treatment for pain management, with no known negative side effects and easy implementation into daily life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inducing positive emotions to reduce chronic pain: a randomized controlled trial of positive psychology exercises. Müller, R., Segerer, W., Ronca, E., et al.[2022]

A new digital intervention app called Strength Back was developed through interviews and focus groups with 21 stakeholders (9 healthcare professionals and 12 spinal surgery patients) to help patients cope with anxiety, pain, and stress before and after spinal surgery.

The app includes 13 modules that provide procedural information and exercises based on Acceptance and Commitment Therapy and positive psychology, aiming to enhance psychological flexibility and improve overall well-being and recovery outcomes for spinal surgery patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strength Back - A qualitative study on the co-creation of a positive psychology digital health intervention for spinal surgery patients. Van Der Horst, AY., Bohlmeijer, ET., Schreurs, KMG., et al.[2023]

A study of 80 individuals living with chronic pain revealed that those who adopted a 'Positive Approach Model' (PAM) demonstrated greater resilience and well-being, emphasizing themes like acceptance, self-efficacy, and social support.

Participants identified integrative therapies and lifestyle behaviors, such as art and spending time in nature, as beneficial, with 'wisdom exemplars' showing significantly higher scores in traits like Openness and Gratitude compared to those with more negative experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stories of Growth and Wisdom: A Mixed-Methods Study of People Living Well With Pain. Owens, JE., Menard, M., Plews-Ogan, M., et al.[2020]

The Positive Emotion Induction (PEI) intervention significantly reduced pain, fear, and anxiety levels in 80 male subjects during a brief pain trial, suggesting its potential effectiveness in acute pain management.

The Brief Relaxation (BR) intervention improved blood pressure recovery but did not affect pain or emotional ratings, indicating that while relaxation techniques may help with physiological responses, they may not directly alleviate pain perception.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Two brief interventions for acute pain. Bruehl, S., Carlson, CR., McCubbin, JA.[2021]

References

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

Behavioral and cognitive-behavioral approaches to chronic pain: recent advances and future directions. [2019]

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

Are reductions in pain intensity and pain-related distress necessary? An analysis of within-treatment change trajectories in relation to improved functioning following interdisciplinary acceptance and commitment therapy for adults with chronic pain. [2022]

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

Evidence-based outcomes in pain research and clinical practice. [2019]

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

Behavioral treatment of chronic pain: variables affecting treatment efficacy. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Goal attainment scaling in evaluating a multidisciplinary pain management programme. [2017]

6. England pubmed.ncbi.nlm.nih.gov

A critical review of behavioural treatments for chronic benign pain other than headache. [2019]

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

The Feasibility of Using the BrightHearts Biofeedback-Assisted Relaxation Application for the Management of Pediatric Procedural Pain: A Pilot Study. [2019]

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

From Fear to Safety: A Roadmap to Recovery From Musculoskeletal Pain. [2022]

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

The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. [2020]

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

Measuring the Cognitions, Emotions, and Motivation Associated With Avoidance Behaviors in the Context of Pain: Preliminary Development of the Negative Responsivity to Pain Scales. [2018]

11. Switzerland pubmed.ncbi.nlm.nih.gov

Exploring Changes in Valued Action in the Presence of Chronic Debilitating Pain in Acceptance and Commitment Therapy for Youth - A Single-Subject Design Study. [2020]

12. England pubmed.ncbi.nlm.nih.gov

Inducing positive emotions to reduce chronic pain: a randomized controlled trial of positive psychology exercises. [2022]

13. Switzerland pubmed.ncbi.nlm.nih.gov

Strength Back - A qualitative study on the co-creation of a positive psychology digital health intervention for spinal surgery patients. [2023]

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

Stories of Growth and Wisdom: A Mixed-Methods Study of People Living Well With Pain. [2020]

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

Two brief interventions for acute pain. [2021]