Pain Disengagement Training for Chronic Pain

Overseen By Ana-Maria Vranceanu, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Massachusetts General Hospital

Disqualifiers: Severe mental health, Suicidality, Cancer, others

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

Compensation: Varies

Number of Visits: 8

Duration: 6 weeks

10 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The investigators aim to conduct an open pilot trial to determine the initial feasibility of a self-directed writing-based intervention in individuals with chronic musculoskeletal pain and elevated pain catastrophizing. The investigators will assess the feasibility of recruitment, acceptability of the treatment, credibility and participant satisfaction, treatment adherence, and feasibility of assessments following pre-specified benchmarks.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, if you have had a significant change in your therapy or medication in the past 3 months, you may not be eligible to participate.

Is Pain Disengagement Training safe for humans?

The research on incorporating walking into cognitive behavioral therapy for chronic pain found that the treatment was safe, with mostly minor and temporary adverse events. ^{1 2 3 4 5}

How is Pain Disengagement Training different from other treatments for chronic pain?

Pain Disengagement Training is unique because it focuses on helping patients shift their attention away from pain, potentially breaking the cycle of fear and avoidance that can worsen chronic pain. This approach is different from traditional treatments that may focus more on medication or physical therapy. ^{6 7 8 9 10}

What data supports the effectiveness of the treatment Pain Disengagement Training for chronic pain?

Research on similar treatments, like mindfulness skills training and self-control training, shows that they can help improve physical and emotional function in people with chronic pain. These treatments often include techniques like relaxation, attention diversion, and gradual activity increases, which have been shown to reduce pain intensity and improve mood. ^{3 9 11 12 13}

Who Is on the Research Team?

Katherine McDermott, PhD

Principal Investigator

Massachusetts General Hospital

Are You a Good Fit for This Trial?

This trial is for individuals with chronic musculoskeletal pain who often find themselves overly focused on their pain (pain catastrophizing). Participants should be willing to try a self-directed writing-based intervention. Specific eligibility details are not provided, so general inclusion would apply.

Inclusion Criteria

Received care at Massachusetts General Hospital

Pain catastrophizing score greater than or equal to 20 on Pain Catastrophizing Scale

I am willing and able to write or type for at least 30 minutes.

Exclusion Criteria

I haven't changed my medication or therapy significantly in the last 3 months.

Severe untreated mental health condition (e.g., psychosis)

Active suicidality with history of plan or current intent

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo Pain Disengagement Training, consisting of approximately 8 sessions with writing exercises focused on imaginal exposure and positive writing

6 weeks

8 sessions (self-directed)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Pain Disengagement Training

Trial Overview The study is testing a new self-help method called Pain Disengagement Training. It's designed to help people manage chronic musculoskeletal pain through writing exercises. The pilot will check if the approach is practical and satisfying for participants.

How Is the Trial Designed?

Group I: Pain Disengagement Training Experimental Treatment 1 Intervention

The intervention involves approximately 8 sessions. The first session will involve a psychoeducation component describing the association between negative emotions and pain and the rationale for the intervention strategies. The intervention sessions will consist of approximately 30 minutes of writing alternating between imaginal exposure writing and positive writing periods alternating back and forth (e.g., 3-5 minutes of imaginal exposure writing followed by 3-5 minutes of positive writing before returning to imaginal exposure writing, etc.). Exposure writing will involve writing about a pain-related catastrophic worry repeatedly until it becomes less anxiety-provoking. The positive writing topics will change with each prompt and will be structured by session theme (e.g., values/goals, meaningful activities). They will also complete between session practice by setting aside a time for worrying and then completing a meaningful activity.

Who Is Running the Clinical Trial?

Massachusetts General Hospital

Lead Sponsor

Trials

3,066

Recruited

13,430,000+

National Center for Complementary and Integrative Health (NCCIH)

Collaborator

Trials

886

Recruited

677,000+

Published Research Related to This Trial

A systematic review of 15 randomized controlled trials involving 1,199 patients found inconclusive evidence for mindfulness skills training (MST) improving self-reported physical function in chronic pain, highlighting variability in how physical function was measured.

Strong evidence indicated that MST did not lead to improvements in physical function when assessed through performance-based measures, suggesting a need for standardized assessment methods in future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical functioning and mindfulness skills training in chronic pain: a systematic review. Jackson, W., Zale, EL., Berman, SJ., et al.[2023]

The GetActive-Fitbit program, a 10-week intervention combining mind-body skills and gradual activity increases, showed potential for improving physical and emotional health in adults with chronic pain, based on a small group of 4 participants.

Participants reported improvements in various outcomes, including physical function, emotional well-being, and pain coping strategies, suggesting that this program could be a credible and useful approach for managing chronic pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Getting Active Mindfully: Rationale and Case Illustration of a Group Mind-body and Activity Program for Chronic Pain. Greenberg, J., Lin, A., Popok, PJ., et al.[2023]

A standardized self-control training program for chronic pain patients, involving techniques like progressive muscle relaxation and pain-control strategies, led to significant improvements in pain intensity and mood among 33 participants after 12 group sessions.

Patients who received the treatment also experienced a notable decrease in depression and other physical complaints, with these benefits maintained at a six-month follow-up, while those on the waiting list showed no changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Self-control training for patients with chronic pain.]. Kaluza, G., Basler, HD.[2021]

This study will evaluate a 6-week self-management program that combines pain science education and exercise for 110 participants with chronic pain, aiming to improve functional outcomes compared to a wait-list control group.

The primary focus is on enhancing function as measured by the Short Musculoskeletal Function Assessment, with secondary outcomes including pain intensity and self-efficacy, which will help identify predictors of treatment response.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chronic pain self-management support with pain science education and exercise (COMMENCE): study protocol for a randomized controlled trial. Miller, J., MacDermid, JC., Walton, DM., et al.[2018]

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]

A 10-week walking program integrated into cognitive behavioral therapy for chronic pain significantly increased participants' daily step counts by an average of 1648 steps, indicating its effectiveness in promoting physical activity.

The program was safe, with mostly minor and temporary adverse events reported, and it was equally effective whether delivered in person or via interactive voice response, suggesting flexibility in treatment delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Incorporating walking into cognitive behavioral therapy for chronic pain: safety and effectiveness of a personalized walking intervention. Heapy, AA., Tankha, H., Higgins, DM., et al.[2023]

A systematic review of nine studies on educational interventions for chronic pain found that education alone does not significantly reduce pain or disability in adults, with pooled data showing no improvement compared to usual care.

The only positive outcome was observed with pain neurophysiology education (PNE), which showed a decrease in disability and improved knowledge about pain, but the evidence is not strong enough to recommend PNE as a standalone treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of education to facilitate knowledge about chronic pain for adults: a systematic review with meta-analysis. Geneen, LJ., Martin, DJ., Adams, N., et al.[2022]

Cognitive Behavioral Therapy (CBT) was found to reduce pain intensity in 43% of the 35 studies reviewed, indicating its potential effectiveness for individuals with chronic pain.

Both online and in-person delivery methods of CBT showed comparable efficacy, suggesting flexibility in how therapy can be administered to patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chronic Pain and Cognitive Behavioral Therapy: An Integrative Review. Knoerl, R., Lavoie Smith, EM., Weisberg, J.[2022]

Behavioral activation (BA) shows promise as a treatment for chronic pain by encouraging individuals to engage in activities that align with their long-term goals, potentially breaking the cycle of pain, fear, and avoidance.

A case study of a veteran with chronic pain demonstrated that gradually increasing participation in previously avoided activities can improve both physical and emotional well-being, suggesting BA could be an effective therapeutic approach for chronic pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaptation of behavioral activation in the treatment of chronic pain. Kim, EH., Crouch, TB., Olatunji, BO.[2018]

Citations

1. New Zealand pubmed.ncbi.nlm.nih.gov

Physical functioning and mindfulness skills training in chronic pain: a systematic review. [2023]

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

Getting Active Mindfully: Rationale and Case Illustration of a Group Mind-body and Activity Program for Chronic Pain. [2023]

3. Germany pubmed.ncbi.nlm.nih.gov

[Self-control training for patients with chronic pain.]. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Chronic pain self-management support with pain science education and exercise (COMMENCE): study protocol for a randomized controlled trial. [2018]

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

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

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

Incorporating walking into cognitive behavioral therapy for chronic pain: safety and effectiveness of a personalized walking intervention. [2023]

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

The optimal dose of pain neuroscience education added to an exercise programme for patients with chronic spinal pain: A systematic review and dose-response meta-analysis. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Effects of education to facilitate knowledge about chronic pain for adults: a systematic review with meta-analysis. [2022]

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

Chronic Pain and Cognitive Behavioral Therapy: An Integrative Review. [2022]

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

Adaptation of behavioral activation in the treatment of chronic pain. [2018]

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

EMDR in the treatment of chronic pain. [2011]

12. Canada pubmed.ncbi.nlm.nih.gov

Internet-Delivered Dialectical Behavioral Therapy Skills Training for Chronic Pain: Protocol for a Randomized Controlled Trial. [2023]

13. England pubmed.ncbi.nlm.nih.gov

An attentional perspective on differential fear conditioning in chronic pain: The informational value of safety cues. [2021]