Pain coping skills training for African Americans with osteoarthritis: results of a randomized controlled trial

Abstract

African Americans bear a disproportionate burden of osteoarthritis (OA), but they have been underrepresented in trials of behavioral interventions for pain. This trial examined a culturally tailored pain coping skills training (CST) program, compared to a wait list control group, among 248 African Americans with knee or hip OA. The pain CST program involved 11 telephone-based sessions over 3 months. Outcomes were assessed at baseline, 3 months (primary), and 9 months, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (primary outcome), WOMAC total score and function subscale, PROMIS Pain Interference, Short-Form 12 Mental and Physical Composite Subscales, Coping Strategies Questionnaire—Total Coping Attempts, Pain Catastrophizing Scale, Patient Health Questionnaire-8, Arthritis Self-Efficacy Scale, and Patient Global Impression of Arthritis Symptom Change. Linear mixed models were fit for all outcomes. There were no significant between-group differences in WOMAC pain score at 3 months (20.63 [95% confidence interval 21.45, 0.18]; P = 0.128) or 9 months (20.84 [95% confidence interval 21.73, 0.06]; P = 0.068). Among secondary outcomes, at 3 months, there were significant differences, in favor of the CST group, for Coping Strategies Questionnaire Total Coping Attempts, Pain Catastrophizing Scale, Arthritis Self-Efficacy, and Patient Global Impression of Arthritis Symptom Change (P < 0.01). Coping Strategies Questionnaire Total Coping Attempts, Arthritis Self-Efficacy, and Patient Global Assessment Change were also significantly improved at 9 months in the CST group, compared with wait list (P < 0.01). The culturally tailored pain CST program did not significantly reduce pain severity but did improve key measures of pain coping and perceived ability to manage pain among African Americans with OA.

No effect of cognitive behavioral patient education for patients with pain catastrophizing before total knee arthroplasty: a randomized controlled trial

“…Recent research on the effect of CBT on pain severity has shown mixed results and meta analyses show that the effect size on pain is small (Dixon et al 2007, Williams et al 2012. Some studies report substantial improvements in patients with knee osteoarthritis (Somers et al 2012, Cai et al 2018 while others report no effect on pain when comparing a CBT group with a usual care group (Helminen et al 2015, Broderick et al 2016, Allen et al 2019, Riddle et al 2019.…”

Acceptability of telephone-based pain coping skills training among African Americans with osteoarthritis enrolled in a randomized controlled trial: a mixed methods analysis

“…Following this adaptation, a randomized controlled trial examined the effectiveness of the culturally-enhanced pain CST program, delivered via telephone over 3 months, among African Americans with OA. Participants who received the pain CST intervention had significant improvements in pain coping and arthritis self-efficacy, immediately following program completion, compared with a waitlist control group [14].…”

“…The STAART Study was a randomized controlled trial of 248 African Americans with symptomatic hip or knee OA [13,14]. Half of the participants were recruited from the University of North Carolina (UNC) Healthcare System and half were from the Durham Veteran Healthcare System (DVAHCS).…”

“…STAART participants were randomized equally to pain CST and waitlist control groups in a parallel-group design with blinded researchers [13,14]; these analyses include only the Pain CST group participants. Detailed methods have been published previously, describing the sampling strategy and intervention details [13,14].…”

“…STAART participants were randomized equally to pain CST and waitlist control groups in a parallel-group design with blinded researchers [13,14]; these analyses include only the Pain CST group participants. Detailed methods have been published previously, describing the sampling strategy and intervention details [13,14]. The Pain CST intervention involved 11 phone-based sessions, which were delivered by counselors with experience in psychological interventions; training and fidelity checks of the counselors have been described previously [13].…”