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Optimizing Psychotherapy for Older Veterans With Chronic Pain (OPOVCP)

Primary Purpose

Musculoskeletal Pain

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Emotional Awareness and Expression Therapy
Cognitive Behavior Therapy
Sponsored by
VA Office of Research and Development
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Musculoskeletal Pain focused on measuring Chronic Pain, Psychotherapy, Musculoskeletal Disease

Eligibility Criteria

60 Years - 95 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Eligible Veterans are age 60 to 95 years old and have had at least 3 months of musculoskeletal pain, including the following conditions most likely to benefit from psychosocial intervention based on previous research:

  • regional pain syndromes (e.g., low back, neck, leg, or pelvic pain, or temporomandibular joint disorders);
  • widespread pain syndromes (e.g., fibromyalgia);
  • whiplash;
  • tension headaches; or
  • any combination of these disorders.

Exclusion Criteria:

  • Confirmed hip or knee osteoarthritis without other musculoskeletal pain complaints;
  • Leg pain greater than back pain only without other musculoskeletal pain complaints (to exclude radiculopathy in isolation);
  • EMG-confirmed "tunnel" syndromes (e.g., carpal or tarsal tunnel syndrome) only without other musculoskeletal pain complaints;
  • Autoimmune disease that typically generates pain (e.g., systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, ankylosing spondylitis);
  • Cancer pain, sickle cell disease, neuralgias (e.g., trigeminal neuralgia), burn pain, infection associated with pain (e.g., vertebral infection), cauda equina syndrome, gout, migraine or cluster headaches without additional musculoskeletal pain complaints;
  • Uncontrolled severe psychiatric disorder including current psychotic disorder or severe mood disorder not controlled with medications (e.g., schizophrenia or bipolar I disorder), dissociative identity disorder, or active suicide/violence risk in the past 6 months;
  • Substantial cognitive impairment or dementia (Mini-Mental State Exam (78) score 24);
  • Active severe alcohol or substance use disorder that inhibits the participant's ability to attend session or participate in homework;
  • Currently with pain-related litigation or applying for pain-related compensation or compensation increase, or undergoing compensation re-evaluation (e.g., applying for VA service connection or service connection increase for pain);
  • Patients who have undergone CBT for pain within the last 3 months of enrollment or who are currently receiving CBT or EAET psychotherapy treatment for pain;
  • Unable to fluently read/converse in English;
  • Planning to move from the area in the next 6 months.

Sites / Locations

  • VA Greater Los Angeles Healthcare System, West Los Angeles, CARecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Emotional Awareness and Expression Therapy

Cognitive Behavior Therapy

Arm Description

Seeks to reduce physical (e.g., pain) and emotional (e.g., depression, anxiety) symptoms by helping individuals become aware of their emotions, express them, and resolve emotional conflicts. It will use techniques such as writing about stress, role playing how to handle difficult relationships, recognizing and expressing anger and other feelings, and being more open with others.

Seeks to help individuals function better and improve symptoms by teaching various cognitive and behavioral skills to manage symptoms. It will use techniques such as relaxation training, engaging in pleasant activities, pacing yourself, and changing unhelpful ways of thinking.

Outcomes

Primary Outcome Measures

Mean Pain Severity
Average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10.
Mean Pain Severity
Average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10.

Secondary Outcome Measures

Percent of Group Therapy Sessions Attended
Number of sessions each participant attends divided by 8 sessions (total number of sessions available to attend).
Satisfaction with Therapy and Therapist Scale-Revised
Satisfaction with therapy subscale is the summation of 6 items, each scored 1-5 (1 = maximum dissatisfaction; 5 = maximum satisfaction), yielding a total score between 6 and 30. Satisfaction with therapist subscale is the summation of 6 items, each scored 1-5 (1 = maximum dissatisfaction; 5 = maximum satisfaction), yielding a total score between 6 and 30. Overall satisfaction is an additional single item scored 1-5 (1 = maximum dissatisfaction; 5 = maximum satisfaction). The two subscales and the overall satisfaction item are each reported separately.
PROMIS-Pain Behavior Short Form 7a v1.1
Sum of seven self-report items assessing behaviors associated with pain over the past 7 days. Items range from 1-6 (1 = had no pain; 6 = always), yielding a total score between 7 and 42.
PROMIS-Pain Behavior Short Form 7a v1.1
Sum of seven self-report items assessing behaviors associated with pain over the past 7 days. Items range from 1-6 (1 = had no pain; 6 = always), yielding a total score between 7 and 42.
PROMIS-Pain Interference Short Form 8a v1.0
Sum of eight self-report items assessing interference of pain with daily activities over the past 7 days. Items range from 1-5 (1 = no interference; 5 = maximum interference), yielding a total score between 8 and 40.
PROMIS-Pain Interference Short Form 8a v1.0
Sum of eight self-report items assessing interference of pain with daily activities over the past 7 days. Items range from 1-5 (1 = no interference; 5 = maximum interference), yielding a total score between 8 and 40.
PROMIS-Depression Short Form
Sum of eight self-report items assessing depression and emotional distress over the past 7 days. Items range from 1-5 (1 = never feeling a type of distressing emotion; 5 = always feeling that emotion), yielding a total score between 8 and 40.
PROMIS-Depression Short Form
Sum of eight self-report items assessing depression and emotional distress over the past 7 days. Items range from 1-5 (1 = never feeling a type of distressing emotion; 5 = always feeling that emotion), yielding a total score between 8 and 40.
PROMIS-Anxiety Short Form
Sum of seven self-report items assessing anxiety over the past 7 days. Items range from 1-5 (1 = never experiencing a type of distressing emotion; 5 = always feeling that emotion), yielding a total score between 7 and 35.
PROMIS-Anxiety Short Form
Sum of seven self-report items assessing anxiety over the past 7 days. Items range from 1-5 (1 = never experiencing a type of distressing emotion; 5 = always feeling that emotion), yielding a total score between 7 and 35.
PTSD Symptom Scale
Sum of seventeen self-report items assessing PTSD according to the frequency in which symptoms are experienced over the last two weeks. Items range from 0-3 (0 = not experiencing a symptom; 1 = once per week or less / a little bit / once in a while; 2 = 2 to 4 times per week / somewhat / half the time; 3 = 3 to 5 or more times per week / very much / almost always), yielding a total score between 0 and 51.
PTSD Symptom Scale
Sum of seventeen self-report items assessing PTSD according to the frequency in which symptoms are experienced over the last two weeks. Items range from 0-3 (0 = not experiencing a symptom; 1 = once per week or less / a little bit / once in a while; 2 = 2 to 4 times per week / somewhat / half the time; 3 = 3 to 5 or more times per week / very much / almost always), yielding a total score between 0 and 51.
NIH Toolbox-Positive Affect Short Form
Sum of fifteen self-report items assessing positive affect over the past 7 days. Items range from 1-5 (1 = not at all experiencing a type of positive emotion; 5 = very much feeling that emotion), yielding a total score between 15 and 75.
NIH Toolbox-Positive Affect Short Form
Sum of fifteen self-report items assessing positive affect over the past 7 days. Items range from 1-5 (1 = not at all experiencing a type of positive emotion; 5 = very much feeling that emotion), yielding a total score between 15 and 75.
NIH Toolbox-Purpose and Meaning Short Form
Sum of seven self-report items assessing general feelings of meaning and purpose. Items range from 1-5 (1 = no purpose and meaning; 5 = maximum purpose and meaning), yielding a total score between 7 and 35.
NIH Toolbox-Purpose and Meaning Short Form
Sum of seven self-report items assessing general feelings of meaning and purpose. Items range from 1-5 (1 = no purpose and meaning; 5 = maximum purpose and meaning), yielding a total score between 7 and 35.
NIH Toolbox-Life Satisfaction Short Form
Sum of five self-report items assessing general life satisfaction. Items range from 1-5 (1 = no satisfaction; 5 = maximum satisfaction), yielding a total score between 5 and 25.
NIH Toolbox-Life Satisfaction Short Form
Sum of five self-report items assessing general life satisfaction. Items range from 1-5 (1 = no satisfaction; 5 = maximum satisfaction), yielding a total score between 5 and 25.
PROMIS-Sleep Disturbance Short Form
Sum of eight self-report items assessing sleep disturbance over the past 7 days. Items range from 1-5 (1 = no sleep disturbance; 5 = maximum sleep disturbance), yielding a total score between 8 and 40.
PROMIS-Sleep Disturbance Short Form
Sum of eight self-report items assessing sleep disturbance over the past 7 days. Items range from 1-5 (1 = no sleep disturbance; 5 = maximum sleep disturbance), yielding a total score between 8 and 40.
PROMIS-Fatigue Short Form
Sum of seven self-report items assessing fatigue over the past 7 days. Items range from 1-5 (1 = no fatigue; 5 = maximum fatigue), yielding a total score between 7 and 35.
PROMIS-Fatigue Short Form
Sum of seven self-report items assessing fatigue over the past 7 days. Items range from 1-5 (1 = no fatigue; 5 = maximum fatigue), yielding a total score between 7 and 35.
Ambivalence over Emotional Expression Questionnaire
Sum of fourteen self-report items assessing ambivalence of emotional expression. Items range from 1-5 (1 = no ambivalence; 5 = maximum ambivalence), yielding a total score between 14 and 70.
Ambivalence over Emotional Expression Questionnaire
Sum of fourteen self-report items assessing ambivalence of emotional expression. Items range from 1-5 (1 = no ambivalence; 5 = maximum ambivalence), yielding a total score between 14 and 70.
Emotional Approach Coping Scales
Sum of eight self-report items assessing whether the subject uses an emotional approach to coping when experiencing stress or difficulties. Items range from 1-4 (1 = I don't use this emotional coping strategy; 4 = I use this emotional coping strategy a lot), yielding a total score between 8 and 32.
Emotional Approach Coping Scales
Sum of eight self-report items assessing whether the subject uses an emotional approach to coping when experiencing stress or difficulties. Items range from 1-4 (1 = I don't use this emotional coping strategy; 4 = I use this emotional coping strategy a lot), yielding a total score between 8 and 32.
Pain Catastrophizing Scale
Sum of thirteen self-report items assessing the types of thoughts and feelings experienced with pain. Items range from 0-4 (0 = not experiencing a type of thought / feeling; 5 = experiencing that thought / feeling all the time), yielding a total score between 0 and 52. Higher scores indicate the subject experiences thoughts and emotions that typically catastrophizes their pain.
Pain Catastrophizing Scale
Sum of thirteen self-report items assessing the types of thoughts and feelings experienced with pain. Items range from 0-4 (0 = not experiencing a type of thought / feeling; 5 = experiencing that thought / feeling all the time), yielding a total score between 0 and 52. Higher scores indicate the subject experiences thoughts and emotions that typically catastrophizes their pain.
Survey of Pain Attitudes
Sum of fourteen self-report items assessing the subject's attitude towards their pain. Items range from 0-4 (0 = this attitude is very untrue for me; 4 = this attitude is very true for me), yielding a total score between 0 and 56.
Survey of Pain Attitudes Supplement
Three self-report items assessing the subject's attitude towards their pain. Items range from 0-4 (0 = strongly disagree; 4 = strongly agree). Each item is scored individually.
Survey of Pain Attitudes
Sum of fourteen self-report items assessing the subject's attitude towards their pain. Items range from 0-4 (0 = this attitude is very untrue for me; 4 = this attitude is very true for me), yielding a total score between 0 and 56.
Survey of Pain Attitudes Supplement
Three self-report items assessing the subject's attitude towards their pain. Items range from 0-4 (0 = strongly disagree; 4 = strongly agree). Each item is scored individually.
Beliefs in Pain Control Questionnaire
A list of thirteen statements relating to the subject's general beliefs about pain management. Each statement is rated 0-4 (0= strongly disagree; 4=strongly agree), yielding a total score between 0 and 52.
Beliefs in Pain Control Questionnaire
A list of thirteen statements relating to the subject's general beliefs about pain management. Each statement is rated 0-4 (0= strongly disagree; 4=strongly agree), yielding a total score between 0 and 52.
Pain Beliefs and Perceptions Inventory
Eight self-report items assessing the subject's beliefs and perceptions about their pain. Items range -2 to 2 (-2 = strongly disagree; 2 = strongly agree). Scored with four two-item scales, each yielding a total score between -4 and 4.
Pain Beliefs and Perceptions Inventory
Eight self-report items assessing the subject's beliefs and perceptions about their pain. Items range -2 to 2 (-2 = strongly disagree; 2 = strongly agree). Scored with four two-item scales, each yielding a total score between -4 and 4.
Fourteen-item Coping Strategies Questionnaire
Sum of fourteen self-report items assessing the subject's use of coping strategies. Items range 0-6 (0 = never use this strategy; 6 = always use this strategy), yielding a total score between 0 and 84.
Fourteen-item Coping Strategies Questionnaire
Sum of fourteen self-report items assessing the subject's use of coping strategies. Items range 0-6 (0 = never use this strategy; 6 = always use this strategy), yielding a total score between 0 and 84.
Patient's Gobal Impression of Change Scale
Patient rates on a single item with a scale of 1-7 the change (if any) they've experienced since beginning treatment in the study (1 = no change or condition has worsened; 7 = a great deal better and a considerable improvement that has made all the difference).
Patient's Gobal Impression of Change Scale
Patient rates on a single item with a scale of 1-7 the change (if any) they've experienced since beginning treatment in the study (1 = no change or condition has worsened; 7 = a great deal better and a considerable improvement that has made all the difference).
Working Alliance Inventory Short Form C
Sum of twelve self-report items assessing the subject's thoughts and feelings on their therapist. Items range 1-7 (1 = never; 4 = sometimes; 7 = always), yielding a total score between 12 and 84.
At Least 30% Improvement in Mean Pain Severity
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 8 weeks, and the two scores are compared to see if mean pain severity at 8 weeks is 30% lower than at baseline.
At Least 30% Improvement in Mean Pain Severity
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 20 weeks, and the two scores are compared to see if mean pain severity at 20 weeks is at least 30% lower than at baseline.
At Least 50% Improvement in Mean Pain Severity
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 8 weeks, and the two scores are compared to see if mean pain severity at 8 weeks is at least 50% lower than at baseline.
At Least 50% Improvement in Mean Pain Severity
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 20 weeks, and the two scores are compared to see if mean pain severity at 20 weeks is at least 50% lower than at baseline.
At Least 70% Improvement in Mean Pain Severity
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 8 weeks, and the two scores are compared to see if mean pain severity at 8 weeks is at least 70% lower than at baseline.
At Least 70% Improvement in Mean Pain Severity
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 20 weeks, and the two scores are compared to see if mean pain severity at 20 weeks is at least 70% lower than at baseline.

Full Information

First Posted
April 15, 2019
Last Updated
December 28, 2022
Sponsor
VA Office of Research and Development
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1. Study Identification

Unique Protocol Identification Number
NCT03918642
Brief Title
Optimizing Psychotherapy for Older Veterans With Chronic Pain
Acronym
OPOVCP
Official Title
Optimizing Psychotherapy for Older Veterans With Chronic Pain
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Recruiting
Study Start Date
April 1, 2019 (Actual)
Primary Completion Date
March 29, 2024 (Anticipated)
Study Completion Date
March 29, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
VA Office of Research and Development

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is being performed to compare the effects of two alternate types of psychotherapy, Cognitive Behavior Therapy (CBT) and Emotional Awareness and Expression Therapy (EAET), for chronic musculoskeletal pain in older adults. In addition, the investigators will evaluate which patients respond better to each treatment and further investigate how each treatment works. CBT, which focuses on improving coping skills for pain, is the standard form of psychotherapy offered at VA. EAET instead focuses on understanding how life stress, relationships, and emotions may cause and perpetuate pain. The investigators are performing the study because pain is a large problem among Veterans. Studies show that chronic pain affects as many as 50% of male Veterans and 75% of female Veterans. The investigators are focusing on older adult Veterans because they have the highest rates of chronic pain at VA, perhaps as high as 80%. The investigators are looking at psychotherapy in this study because VA, the Department of Defense, and the CDC recently recommended psychosocial treatments, such as psychotherapy, as first treatments for chronic pain, along with medications other than opioids (e.g., oxycodone). However, only one form of psychotherapy, CBT, is currently available in clinical practice at VA, and this study may provide evidence for making EAET available to Veterans as well.
Detailed Description
The overarching goal of the proposed research is to learn how to optimize psychotherapy for those Veterans most in need and most likely to benefit from psychotherapy, older Veterans with chronic musculoskeletal pain. Chronic pain is a critical healthcare challenge, as the condition affects 50% of all Veterans and affects older Veterans most commonly, severely, and persistently. For years, chronic pain treatment has been notoriously difficult at VA and elsewhere, especially in light of the recent "opioid crisis," in which opioid analgesics, previously a mainstay of chronic pain treatment, have come under increased scrutiny. In response, CDC, VA/DoD, and some experts have called for enhancing and expanding psychosocial treatment options for chronic pain, such as psychotherapy, which are low risk for older Veterans who frequently have multiple medical comorbidities and are taking multiple medications. Yet standard VA psychotherapy approaches, such as Cognitive Behavior Therapy (CBT), have shown modest benefits for Veterans on pain and other related outcomes, such as mood, anxiety, and sleep. In contrast, a novel psychotherapy approach, Emotional Awareness and Expression Therapy (EAET), has shown medium to large benefits for some chronic pain patients. Whereas CBT improves pain and negative emotion by teaching patients cognitive and behavioral coping skills, affecting brain regions that enhance "cognitive control" of pain, EAET operates primarily through emotion regulation, which is thought to influence brain regions and circuits that modulate both physical pain and emotion-a mechanism absent from existing approaches. The literature and the investigators' pilot data indicate that patients who express emotional distress at baseline, such as high anxiety and depressive symptoms, may be particularly likely to benefit from EAET's emotion regulation approach, whereas patients who express less emotional distress may derive more benefit from an approach like CBT, which does not require ready access to emotions. The proposed randomized clinical trial tests the hypothesis that EAET is superior to CBT on reduction in mean pain severity and other outcomes derived from IMMPACT. To examine which patients are most likely to benefit, this research also tests whether greater baseline emotional distress (using measures of anxiety and depression) predicts stronger benefits from EAET and whether lower baseline emotional distress predicts stronger benefits from CBT. Finally, this research explores whether the benefits of EAET are mediated by improved emotion regulation, whether the benefits of CBT are mediated by improved cognitive and behavioral coping, and whether the benefits of both are mediated by a stronger working alliance. The investigators plan to enroll 160 multi-ethnic/multi-racial older Veterans (age 60-95 years) with chronic musculoskeletal pain at the West Los Angeles VA Medical Center. This research can introduce an additional, potentially more effective format of psychotherapy at VA so that more Veterans with chronic pain can respond. In addition, this research can lead to better treatment targeting and enhance the understanding of how psychotherapy treatments work. Finally, this research can facilitate the development of critical skills for the PI in psychotherapy research and pain management and enhance his ability to effect positive change for older Veterans. Recruitment was resumed after the Covid-19 Administrative Hold was lifted in October 2020.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Musculoskeletal Pain
Keywords
Chronic Pain, Psychotherapy, Musculoskeletal Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Two-Group Parallel Comparison Trial
Masking
None (Open Label)
Allocation
Randomized
Enrollment
160 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Emotional Awareness and Expression Therapy
Arm Type
Experimental
Arm Description
Seeks to reduce physical (e.g., pain) and emotional (e.g., depression, anxiety) symptoms by helping individuals become aware of their emotions, express them, and resolve emotional conflicts. It will use techniques such as writing about stress, role playing how to handle difficult relationships, recognizing and expressing anger and other feelings, and being more open with others.
Arm Title
Cognitive Behavior Therapy
Arm Type
Active Comparator
Arm Description
Seeks to help individuals function better and improve symptoms by teaching various cognitive and behavioral skills to manage symptoms. It will use techniques such as relaxation training, engaging in pleasant activities, pacing yourself, and changing unhelpful ways of thinking.
Intervention Type
Behavioral
Intervention Name(s)
Emotional Awareness and Expression Therapy
Other Intervention Name(s)
EAET
Intervention Description
Focus on emotions, writing about stress, assertiveness training, role playing new ways to handle relationships, and sharing feelings and experiences with others.
Intervention Type
Behavioral
Intervention Name(s)
Cognitive Behavior Therapy
Other Intervention Name(s)
CBT
Intervention Description
Focus on cognitive and behavioral skills, such as relaxation, increasing pleasant activities, pacing, and changing ways of thinking.
Primary Outcome Measure Information:
Title
Mean Pain Severity
Description
Average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10.
Time Frame
Change from baseline to 8 weeks
Title
Mean Pain Severity
Description
Average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10.
Time Frame
Change from baseline to 20 weeks
Secondary Outcome Measure Information:
Title
Percent of Group Therapy Sessions Attended
Description
Number of sessions each participant attends divided by 8 sessions (total number of sessions available to attend).
Time Frame
8 weeks
Title
Satisfaction with Therapy and Therapist Scale-Revised
Description
Satisfaction with therapy subscale is the summation of 6 items, each scored 1-5 (1 = maximum dissatisfaction; 5 = maximum satisfaction), yielding a total score between 6 and 30. Satisfaction with therapist subscale is the summation of 6 items, each scored 1-5 (1 = maximum dissatisfaction; 5 = maximum satisfaction), yielding a total score between 6 and 30. Overall satisfaction is an additional single item scored 1-5 (1 = maximum dissatisfaction; 5 = maximum satisfaction). The two subscales and the overall satisfaction item are each reported separately.
Time Frame
8 weeks
Title
PROMIS-Pain Behavior Short Form 7a v1.1
Description
Sum of seven self-report items assessing behaviors associated with pain over the past 7 days. Items range from 1-6 (1 = had no pain; 6 = always), yielding a total score between 7 and 42.
Time Frame
Change from baseline to 8 weeks
Title
PROMIS-Pain Behavior Short Form 7a v1.1
Description
Sum of seven self-report items assessing behaviors associated with pain over the past 7 days. Items range from 1-6 (1 = had no pain; 6 = always), yielding a total score between 7 and 42.
Time Frame
Change from baseline to 20 weeks
Title
PROMIS-Pain Interference Short Form 8a v1.0
Description
Sum of eight self-report items assessing interference of pain with daily activities over the past 7 days. Items range from 1-5 (1 = no interference; 5 = maximum interference), yielding a total score between 8 and 40.
Time Frame
Change from baseline to 8 weeks
Title
PROMIS-Pain Interference Short Form 8a v1.0
Description
Sum of eight self-report items assessing interference of pain with daily activities over the past 7 days. Items range from 1-5 (1 = no interference; 5 = maximum interference), yielding a total score between 8 and 40.
Time Frame
Change from baseline to 20 weeks
Title
PROMIS-Depression Short Form
Description
Sum of eight self-report items assessing depression and emotional distress over the past 7 days. Items range from 1-5 (1 = never feeling a type of distressing emotion; 5 = always feeling that emotion), yielding a total score between 8 and 40.
Time Frame
Change from baseline to 8 weeks
Title
PROMIS-Depression Short Form
Description
Sum of eight self-report items assessing depression and emotional distress over the past 7 days. Items range from 1-5 (1 = never feeling a type of distressing emotion; 5 = always feeling that emotion), yielding a total score between 8 and 40.
Time Frame
Change from baseline to 20 weeks
Title
PROMIS-Anxiety Short Form
Description
Sum of seven self-report items assessing anxiety over the past 7 days. Items range from 1-5 (1 = never experiencing a type of distressing emotion; 5 = always feeling that emotion), yielding a total score between 7 and 35.
Time Frame
Change from baseline to 8 weeks
Title
PROMIS-Anxiety Short Form
Description
Sum of seven self-report items assessing anxiety over the past 7 days. Items range from 1-5 (1 = never experiencing a type of distressing emotion; 5 = always feeling that emotion), yielding a total score between 7 and 35.
Time Frame
Change from baseline to 20 weeks
Title
PTSD Symptom Scale
Description
Sum of seventeen self-report items assessing PTSD according to the frequency in which symptoms are experienced over the last two weeks. Items range from 0-3 (0 = not experiencing a symptom; 1 = once per week or less / a little bit / once in a while; 2 = 2 to 4 times per week / somewhat / half the time; 3 = 3 to 5 or more times per week / very much / almost always), yielding a total score between 0 and 51.
Time Frame
Change from baseline to 8 weeks
Title
PTSD Symptom Scale
Description
Sum of seventeen self-report items assessing PTSD according to the frequency in which symptoms are experienced over the last two weeks. Items range from 0-3 (0 = not experiencing a symptom; 1 = once per week or less / a little bit / once in a while; 2 = 2 to 4 times per week / somewhat / half the time; 3 = 3 to 5 or more times per week / very much / almost always), yielding a total score between 0 and 51.
Time Frame
Change from baseline to 20 weeks
Title
NIH Toolbox-Positive Affect Short Form
Description
Sum of fifteen self-report items assessing positive affect over the past 7 days. Items range from 1-5 (1 = not at all experiencing a type of positive emotion; 5 = very much feeling that emotion), yielding a total score between 15 and 75.
Time Frame
Change from baseline to 8 weeks
Title
NIH Toolbox-Positive Affect Short Form
Description
Sum of fifteen self-report items assessing positive affect over the past 7 days. Items range from 1-5 (1 = not at all experiencing a type of positive emotion; 5 = very much feeling that emotion), yielding a total score between 15 and 75.
Time Frame
Change from baseline to 20 weeks
Title
NIH Toolbox-Purpose and Meaning Short Form
Description
Sum of seven self-report items assessing general feelings of meaning and purpose. Items range from 1-5 (1 = no purpose and meaning; 5 = maximum purpose and meaning), yielding a total score between 7 and 35.
Time Frame
Change from baseline to 8 weeks
Title
NIH Toolbox-Purpose and Meaning Short Form
Description
Sum of seven self-report items assessing general feelings of meaning and purpose. Items range from 1-5 (1 = no purpose and meaning; 5 = maximum purpose and meaning), yielding a total score between 7 and 35.
Time Frame
Change from baseline to 20 weeks
Title
NIH Toolbox-Life Satisfaction Short Form
Description
Sum of five self-report items assessing general life satisfaction. Items range from 1-5 (1 = no satisfaction; 5 = maximum satisfaction), yielding a total score between 5 and 25.
Time Frame
Change from baseline to 8 weeks
Title
NIH Toolbox-Life Satisfaction Short Form
Description
Sum of five self-report items assessing general life satisfaction. Items range from 1-5 (1 = no satisfaction; 5 = maximum satisfaction), yielding a total score between 5 and 25.
Time Frame
Change from baseline to 20 weeks
Title
PROMIS-Sleep Disturbance Short Form
Description
Sum of eight self-report items assessing sleep disturbance over the past 7 days. Items range from 1-5 (1 = no sleep disturbance; 5 = maximum sleep disturbance), yielding a total score between 8 and 40.
Time Frame
Change from baseline to 8 weeks
Title
PROMIS-Sleep Disturbance Short Form
Description
Sum of eight self-report items assessing sleep disturbance over the past 7 days. Items range from 1-5 (1 = no sleep disturbance; 5 = maximum sleep disturbance), yielding a total score between 8 and 40.
Time Frame
Change from baseline to 20 weeks
Title
PROMIS-Fatigue Short Form
Description
Sum of seven self-report items assessing fatigue over the past 7 days. Items range from 1-5 (1 = no fatigue; 5 = maximum fatigue), yielding a total score between 7 and 35.
Time Frame
Change from baseline to 8 weeks
Title
PROMIS-Fatigue Short Form
Description
Sum of seven self-report items assessing fatigue over the past 7 days. Items range from 1-5 (1 = no fatigue; 5 = maximum fatigue), yielding a total score between 7 and 35.
Time Frame
Change from baseline to 20 weeks
Title
Ambivalence over Emotional Expression Questionnaire
Description
Sum of fourteen self-report items assessing ambivalence of emotional expression. Items range from 1-5 (1 = no ambivalence; 5 = maximum ambivalence), yielding a total score between 14 and 70.
Time Frame
Change from baseline to 8 weeks
Title
Ambivalence over Emotional Expression Questionnaire
Description
Sum of fourteen self-report items assessing ambivalence of emotional expression. Items range from 1-5 (1 = no ambivalence; 5 = maximum ambivalence), yielding a total score between 14 and 70.
Time Frame
Change from baseline to 20 weeks
Title
Emotional Approach Coping Scales
Description
Sum of eight self-report items assessing whether the subject uses an emotional approach to coping when experiencing stress or difficulties. Items range from 1-4 (1 = I don't use this emotional coping strategy; 4 = I use this emotional coping strategy a lot), yielding a total score between 8 and 32.
Time Frame
Change from baseline to 8 weeks
Title
Emotional Approach Coping Scales
Description
Sum of eight self-report items assessing whether the subject uses an emotional approach to coping when experiencing stress or difficulties. Items range from 1-4 (1 = I don't use this emotional coping strategy; 4 = I use this emotional coping strategy a lot), yielding a total score between 8 and 32.
Time Frame
Change from baseline to 20 weeks
Title
Pain Catastrophizing Scale
Description
Sum of thirteen self-report items assessing the types of thoughts and feelings experienced with pain. Items range from 0-4 (0 = not experiencing a type of thought / feeling; 5 = experiencing that thought / feeling all the time), yielding a total score between 0 and 52. Higher scores indicate the subject experiences thoughts and emotions that typically catastrophizes their pain.
Time Frame
Change from baseline to 8 weeks
Title
Pain Catastrophizing Scale
Description
Sum of thirteen self-report items assessing the types of thoughts and feelings experienced with pain. Items range from 0-4 (0 = not experiencing a type of thought / feeling; 5 = experiencing that thought / feeling all the time), yielding a total score between 0 and 52. Higher scores indicate the subject experiences thoughts and emotions that typically catastrophizes their pain.
Time Frame
Change from baseline to 20 weeks
Title
Survey of Pain Attitudes
Description
Sum of fourteen self-report items assessing the subject's attitude towards their pain. Items range from 0-4 (0 = this attitude is very untrue for me; 4 = this attitude is very true for me), yielding a total score between 0 and 56.
Time Frame
Change from baseline to 8 weeks
Title
Survey of Pain Attitudes Supplement
Description
Three self-report items assessing the subject's attitude towards their pain. Items range from 0-4 (0 = strongly disagree; 4 = strongly agree). Each item is scored individually.
Time Frame
Change from baseline to 8 weeks
Title
Survey of Pain Attitudes
Description
Sum of fourteen self-report items assessing the subject's attitude towards their pain. Items range from 0-4 (0 = this attitude is very untrue for me; 4 = this attitude is very true for me), yielding a total score between 0 and 56.
Time Frame
Change from baseline to 20 weeks
Title
Survey of Pain Attitudes Supplement
Description
Three self-report items assessing the subject's attitude towards their pain. Items range from 0-4 (0 = strongly disagree; 4 = strongly agree). Each item is scored individually.
Time Frame
Change from baseline to 20 weeks
Title
Beliefs in Pain Control Questionnaire
Description
A list of thirteen statements relating to the subject's general beliefs about pain management. Each statement is rated 0-4 (0= strongly disagree; 4=strongly agree), yielding a total score between 0 and 52.
Time Frame
Change from baseline to 8 weeks
Title
Beliefs in Pain Control Questionnaire
Description
A list of thirteen statements relating to the subject's general beliefs about pain management. Each statement is rated 0-4 (0= strongly disagree; 4=strongly agree), yielding a total score between 0 and 52.
Time Frame
Change from baseline to 20 weeks
Title
Pain Beliefs and Perceptions Inventory
Description
Eight self-report items assessing the subject's beliefs and perceptions about their pain. Items range -2 to 2 (-2 = strongly disagree; 2 = strongly agree). Scored with four two-item scales, each yielding a total score between -4 and 4.
Time Frame
Change from baseline to 8 weeks
Title
Pain Beliefs and Perceptions Inventory
Description
Eight self-report items assessing the subject's beliefs and perceptions about their pain. Items range -2 to 2 (-2 = strongly disagree; 2 = strongly agree). Scored with four two-item scales, each yielding a total score between -4 and 4.
Time Frame
Change from baseline to 20 weeks
Title
Fourteen-item Coping Strategies Questionnaire
Description
Sum of fourteen self-report items assessing the subject's use of coping strategies. Items range 0-6 (0 = never use this strategy; 6 = always use this strategy), yielding a total score between 0 and 84.
Time Frame
Change from baseline to 8 weeks
Title
Fourteen-item Coping Strategies Questionnaire
Description
Sum of fourteen self-report items assessing the subject's use of coping strategies. Items range 0-6 (0 = never use this strategy; 6 = always use this strategy), yielding a total score between 0 and 84.
Time Frame
Change from baseline to 20 weeks
Title
Patient's Gobal Impression of Change Scale
Description
Patient rates on a single item with a scale of 1-7 the change (if any) they've experienced since beginning treatment in the study (1 = no change or condition has worsened; 7 = a great deal better and a considerable improvement that has made all the difference).
Time Frame
Change from baseline to 8 weeks
Title
Patient's Gobal Impression of Change Scale
Description
Patient rates on a single item with a scale of 1-7 the change (if any) they've experienced since beginning treatment in the study (1 = no change or condition has worsened; 7 = a great deal better and a considerable improvement that has made all the difference).
Time Frame
Change from baseline to 20 weeks
Title
Working Alliance Inventory Short Form C
Description
Sum of twelve self-report items assessing the subject's thoughts and feelings on their therapist. Items range 1-7 (1 = never; 4 = sometimes; 7 = always), yielding a total score between 12 and 84.
Time Frame
8 weeks
Title
At Least 30% Improvement in Mean Pain Severity
Description
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 8 weeks, and the two scores are compared to see if mean pain severity at 8 weeks is 30% lower than at baseline.
Time Frame
Change from baseline to 8 weeks
Title
At Least 30% Improvement in Mean Pain Severity
Description
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 20 weeks, and the two scores are compared to see if mean pain severity at 20 weeks is at least 30% lower than at baseline.
Time Frame
Change from baseline to 20 weeks
Title
At Least 50% Improvement in Mean Pain Severity
Description
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 8 weeks, and the two scores are compared to see if mean pain severity at 8 weeks is at least 50% lower than at baseline.
Time Frame
Change from baseline to 8 weeks
Title
At Least 50% Improvement in Mean Pain Severity
Description
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 20 weeks, and the two scores are compared to see if mean pain severity at 20 weeks is at least 50% lower than at baseline.
Time Frame
Change from baseline to 20 weeks
Title
At Least 70% Improvement in Mean Pain Severity
Description
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 8 weeks, and the two scores are compared to see if mean pain severity at 8 weeks is at least 70% lower than at baseline.
Time Frame
Change from baseline to 8 weeks
Title
At Least 70% Improvement in Mean Pain Severity
Description
Mean pain severity is calculated from an average of 4 self report items: current pain, worst pain over the last 7 days, least pain over the last 7 days, and average pain over the last 7 days. Each item is scored 0-10 (0 = no pain; 10 = pain as bad as can be), yielding a total score between 0 and 10. Mean pain severity is calculated at baseline and 20 weeks, and the two scores are compared to see if mean pain severity at 20 weeks is at least 70% lower than at baseline.
Time Frame
Change from baseline to 20 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
60 Years
Maximum Age & Unit of Time
95 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Eligible Veterans are age 60 to 95 years old and have had at least 3 months of musculoskeletal pain, including the following conditions most likely to benefit from psychosocial intervention based on previous research: regional pain syndromes (e.g., low back, neck, leg, or pelvic pain, or temporomandibular joint disorders); widespread pain syndromes (e.g., fibromyalgia); whiplash; tension headaches; or any combination of these disorders. Exclusion Criteria: Confirmed hip or knee osteoarthritis without other musculoskeletal pain complaints; Leg pain greater than back pain only without other musculoskeletal pain complaints (to exclude radiculopathy in isolation); EMG-confirmed "tunnel" syndromes (e.g., carpal or tarsal tunnel syndrome) only without other musculoskeletal pain complaints; Autoimmune disease that typically generates pain (e.g., systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, ankylosing spondylitis); Cancer pain, sickle cell disease, neuralgias (e.g., trigeminal neuralgia), burn pain, infection associated with pain (e.g., vertebral infection), cauda equina syndrome, gout, migraine or cluster headaches without additional musculoskeletal pain complaints; Uncontrolled severe psychiatric disorder including current psychotic disorder or severe mood disorder not controlled with medications (e.g., schizophrenia or bipolar I disorder), dissociative identity disorder, or active suicide/violence risk in the past 6 months; Substantial cognitive impairment or dementia (Mini-Mental State Exam (78) score 24); Active severe alcohol or substance use disorder that inhibits the participant's ability to attend session or participate in homework; Currently with pain-related litigation or applying for pain-related compensation or compensation increase, or undergoing compensation re-evaluation (e.g., applying for VA service connection or service connection increase for pain); Patients who have undergone CBT for pain within the last 3 months of enrollment or who are currently receiving CBT or EAET psychotherapy treatment for pain; Unable to fluently read/converse in English; Planning to move from the area in the next 6 months.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Brandon C Yarns, MD MS BME
Phone
(310) 478-3711
Ext
42764
Email
Brandon.Yarns@va.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Brandon C Yarns, MD MS BME
Organizational Affiliation
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
Official's Role
Principal Investigator
Facility Information:
Facility Name
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
City
West Los Angeles
State/Province
California
ZIP/Postal Code
90073
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Brandon C Yarns, MD MS BME
Phone
310-478-3711
Ext
42764
Email
Brandon.Yarns@va.gov
First Name & Middle Initial & Last Name & Degree
Brandon C Yarns, MD MS BME

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Optimizing Psychotherapy for Older Veterans With Chronic Pain

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