Preoperative cognitive–behavioral therapy for reducing pain catastrophizing and improving pain outcomes after total knee replacement: a randomized clinical trial

2021 ◽  
pp. rapm-2020-102258
Author(s):  
Asokumar Buvanendran ◽  
Amanda C Sremac ◽  
Patricia A Merriman ◽  
Craig J Della Valle ◽  
John W Burns ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Phase 1 ◽  
Cognitive Behavioral ◽  
Womac Pain ◽  
Phase 2 ◽  
Pain Subscale ◽  
Pain Outcomes ◽  
Total Knee

IntroductionCognitive–behavioral therapy (CBT) can reduce preoperative pain catastrophizing and may improve postsurgical pain outcomes. We hypothesized that CBT would reduce pain catastrophizing more than no-CBT controls and result in improved pain outcomes.MethodsThe study was a randomized controlled trial of patients undergoing elective total knee arthroplasty between January 2013 and March 2020. In phase 1, the change in pain catastrophizing scores (PCS) among 4-week or 8-week telehealth, 4-week in person and no-CBT sessions was compared in 80 patients with a PCS >16. In phase 2, the proportion of subjects that achieved a 3-month decrease in Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale >4 following 4-week telehealth CBT with no-CBT controls were compared in 80 subjects.ResultsIn phase 1, 4-week telehealth CBT had the highest completion rate 17/20 (85%), demonstrated an adjusted median reduction in PCS of −9 (95% CI −1 to −14, p<0.01) compared with no-CBT and was non-inferior to 8-week telehealth CBT at a margin of 2 (p=0.02). In phase 2, 29 of 35 (83%) in the 4-week telehealth CBT and 26 of 33 (79%) subjects in the no-CBT demonstrated a decrease in the WOMAC pain subscale >4 at 3 months, difference 4% (95% CI −18% to 26%, p=0.48), despite a median decrease in the PCS for the 4-week CBT and no-CBT group of −6 (−10 to −2, p=0.02).ConclusionsOur findings demonstrate that CBT interventions delivered prior to surgery in person or via telehealth can reduced PCS scores; however, this reduction did not lead to improved 3-month pain outcomes.Trial registration numberClinicalTrials.gov (NCT 01772329, registration date 21 January 2013).

Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up

Pain Medicine ◽  
2021 ◽  
Author(s):  
Matthew E Schumann ◽  
Brandon J Coombes ◽  
Keith E Gascho ◽  
Jennifer R Geske ◽  
Mary C McDermott ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Self Efficacy ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Rehabilitation Program ◽  
Cognitive Behavioral ◽  
Pain Outcomes ◽  
Pain Symptoms

Abstract Background Decreasing pain catastrophizing and improving self-efficacy to self-manage chronic pain symptoms are important treatment targets in the context of interdisciplinary cognitive behavioral therapy for chronic pain. Greater pain catastrophizing has been shown to be associated with greater impact of pain symptoms on functioning, while conversely, greater pain self-efficacy has been associated with lower pain intensity and lower levels of disability. Objective To prospectively evaluate interdisciplinary cognitive behavioral therapy for pain outcomes, as well as to the mediating effects of both pain catastrophizing and pain self-efficacy on outcome. Methods Participants were 315 patients with chronic pain between April 2017 and April 2018 who completed a three-week interdisciplinary pain rehabilitation program. Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, and depressive symptom questionnaires, and measures of physical performance were assessed at pre- and posttreatment. Follow-up questionnaires were returned by 163 participants. Effect size and reliable change analyses were conducted from pre- to posttreatment and pretreatment to 6-month follow-up. Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome. Results Significant improvements from pre- to posttreatment in pain outcomes were observed, and over 80% evidenced reliable change in at least one pain-relevant measure. Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes. Conclusions Interdisciplinary pain rehabilitation is an effective treatment and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains.

scholarly journals A Mobile Phone–Based App for Use During Cognitive Behavioral Therapy for Adolescents With Anxiety (MindClimb): User-Centered Design and Usability Study

10.2196/18439 ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. e18439
Author(s):  
Amanda Newton ◽  
Alexa Bagnell ◽  
Rhonda Rosychuk ◽  
Janelle Duguay ◽  
Lori Wozney ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Clinical Care ◽  
Phase 1 ◽  
Average Score ◽  
High Fidelity ◽  
Heuristic Evaluation ◽  
Phase 2 ◽  
Phase 3 ◽  
System Usability

Background Mobile device–based tools to help adolescents practice skills outside of cognitive behavioral therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. Objective This study aimed to develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, a smartphone-based app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. Methods This 3-phase study took place from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, we conducted 2 high-fidelity testing sessions using the think-aloud approach (acceptability, learnability, usability) and 10-item System Usability Scale with 10 adolescents receiving CBT. The high-fidelity MindClimb app was evaluated by 5 app developers based on Nielsen’s usability heuristics and 5-point severity ranking scale. In phase 3, a total of 8 adolescents and 3 therapists assessed the usability of MindClimb during CBT sessions by recording the frequency of skills practice, use of MindClimb features, satisfaction with the app, and barriers and facilitators to app use during treatment. Results Feedback from phase 1 consultations indicated that the app should (1) be responsive to user needs and preferences, (2) be easy to use and navigate, (3) have relevant content to the practice of CBT for anxiety, and (4) be aesthetically appealing. Using this feedback as a guide, a fully functional app prototype for usability testing and heuristic evaluation was developed. In phase 2, think-aloud and usability data resulted in minor revisions to the app, including refinement of exposure activities. The average system usability score was 77 in both testing cycles, indicating acceptable usability. The heuristic evaluation by app developers identified only minor errors (eg, loading speed of app content, with a score of 1 on the severity ranking scale). In phase 3, adolescents considered app features for completing exposure (6.2/10) and relaxation (6.4/10) modestly helpful. Both adolescents (average score 11.3/15, SD 1.6) and therapists (average score 10.0/12, 2.6 SD) reported being satisfied with the app. Conclusions The user-centered approach to developing and testing MindClimb resulted in a mobile health app that can be used by adolescents during CBT for anxiety. Evaluation of the use of this app in a clinical practice setting demonstrated that adolescents and therapists generally felt it was helpful for CBT practice outside of therapy sessions. Implementation studies with larger youth samples are necessary to evaluate how to optimize the use of technology in clinical care and examine the impact of the app plus CBT on clinical care processes and patient outcomes.

scholarly journals Pain in Patients with Chronic Fatigue Syndrome: Time for Specific Pain Treatment?

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. E677-E686
Author(s):  
Jo Nijs
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioral Therapy ◽  
Central Sensitization ◽  
Pain Treatment ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Chronic Fatigue ◽  
Cognitive Behavioral ◽  
Fatigue Syndrome ◽  
Endogenous Analgesia

Background: Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers. Objectives: To examine whether pain is a unique feature of CFS, or does it share the same underlying mechanisms as other CFS symptoms? Second, it is examined whether effective treatments for pain from CFS are currently available. Study Design: Narrative review covering the scientific literature up through December 2011. Setting: Several universities. Results: From the available literature, it is concluded that musculoskeletal factors are unlikely to account for pain from CFS. Pain seems to be one out of many symptoms related to central sensitization from CFS. This idea is supported by the findings of generalized hyperalgesia (including widespread increased responsiveness to painful stimuli) and dysfunctional endogenous analgesia in response to noxious thermal stimuli. Pain catastrophizing and depression partly account for pain from CFS. Pain increases during exercise is probably due to the lack of endogenous analgesia and activation of several genes in response to exercise in CFS. There is currently no evidence in support for the efficacy of complementary medicine in the treatment of pain from CFS. Intensive education about the biology of pain from CFS (within the framework of central sensitization) has positive short-term effects for patients with CFS, and fatigue-targeting cognitive behavioral therapy appears to be effective for pain from CFS as well. Limitations: The role of the deficient hypothalamus-pituitary-adrenal axis in relation to pain from CFS, as well as the interactions with immune (dys)functioning require further study. Conclusion: Recent research has increased our understanding of pain from CFS, including its treatment. It is advocated to optimize current CFS treatment protocols by targeting the underlying mechanism for those patients having severe pain. Key words: Chronic pain, chronic fatigue syndrome, fibromyalgia, central sensitization, catastrophizing, exercise, cognitive behavioral therapy.

scholarly journals Efficacy of Cognitive Behavioral Therapy in Managing Chronic Pain of Degenerative Conditions: An Overview of Randomized Clinical Trials and Meta-Analysis Studies

2020 ◽  
Vol 2 (1) ◽  
pp. 27-31
Author(s):  
Nchawanangwa Kaonga ◽  
◽  
Charity Kapenda ◽  
James Mwanza ◽  
Brian Chanda Chiluba ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Randomized Clinical Trials ◽  
Cognitive Distortions ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Good Evidence ◽  
Cognitive Behavioral ◽  
Relaxation Techniques

Background:Cognitive behavioral therapy is a goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. It has been documented in various studies to have an impact when used in the management of chronic pain. It has been shown to lack the drawbacks of pharmacological and surgical treatments such as addiction and toxicity; and cost and recovery time, respectively. Cognitive behavioral therapy has also been shown to target cognitive distortions such as pain catastrophizing among other things. The objective of the review is to evaluate the effectiveness of cognitive behavioral therapy in the management of chronic pain of degenerative conditions. Methods:This review article was conducted basing on the previous studies published from 2009-2019 and data analyzed was retrieved from Google Scholar, Elsevier and Science Direct. Only the articles that looked at effectiveness of cognitive behavioral therapy in the management of chronic pain from a physiotherapists point were included. Results:The outcomes of the studies used varied and included reduction in pain intensity, pain disability, fear avoidance, catastrophizing and kinesophobia. The CBT approaches used across the studies also varied and included operant conditioning, biofeedback, relaxation techniques, pacing, cognitive coping techniques, graded activity and graded exposure.Conclusion:Published randomized controlled trials provide good evidence for the effectiveness of cognitive behavioral therapy and how specific approaches may vary in effectiveness depending on the desired outcomes

scholarly journals A Novel Exercise Facilitation Method in Combination with Cognitive Behavioral Therapy Using the Ikiiki Rehabilitation Notebook for Intractable Chronic Pain: Technical Report and 22 Cases

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1209
Author(s):  
Shinji Kimura ◽  
Masako Hosoi ◽  
Naofumi Otsuru ◽  
Madoka Iwasaki ◽  
Takako Matsubara ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Rating Scale ◽  
School Attendance ◽  
Numerical Rating Scale ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Technical Report ◽  
Numerical Rating

Recent clinical practice guidelines for chronic pain indicate, with a high evidence level, that the combination of exercise and cognitive behavioral therapy (CBT) is effective. The purpose of this study was to evaluate the effectiveness of an exercise facilitation method in combination with CBT using the “Ikiiki Rehabilitation Notebook” for patients with intractable chronic pain. “Ikiiki” means active in Japanese. A total of 22 cases with chronic low back (n = 13), lower extremity (n = 8), or neck (n = 1) pain were treated using this notebook. Two cases dropped out, leaving 22 cases. Each case was evaluated in terms of the numerical rating scale (NRS) of the pain, activities of daily living (ADL), pain catastrophizing scale (PCS), and quality of life (QOL) at pretreatment and post-treatment. The endpoint of the method was to achieve the long-term goals set by the patients. The mean treatment period was 11.2 months. The outcomes were as follows: improvement of presenteeism: nine cases; enhanced participation in hobbies: seven cases; improved school attendance: two cases; return to work: one case; improvement of self-care and/or self-efficacy: three cases. The NRS, ADL, PCS, and QOL were significantly improved after the treatment. This method is possibly valuable for educating patients about the cause and treatment of chronic pain and actively facilitating exercise and social participation. Further studies are needed to investigate the effectiveness of using this notebook for the patient with intractable chronic pain.

scholarly journals A randomized controlled TRIal of cognitive BEhavioral therapy for high Catastrophizing in patients undergoing lumbar fusion surgery: the TRIBECA study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
P. Scarone ◽  
A. Y. J. M. Smeets ◽  
S. M. J. van Kuijk ◽  
H. van Santbrink ◽  
M. Peters ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Spinal Fusion ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Fusion Surgery ◽  
Postsurgical Pain ◽  
Spinal Fusion Surgery ◽  
Randomized Controlled ◽  
Chronic Postsurgical Pain

Abstract Background Around 20% of patients undergoing spinal fusion surgery have persistent back or leg pain despite surgery. Pain catastrophizing is the strongest psychological predictor for chronic postsurgical pain. Psychological variables are modifiable and could be target for intervention. However, randomized controlled trials evaluating the effectiveness of psychological interventions to reduce chronic pain and disability after spinal fusion in a population of patients with high preoperative pain catastrophizing scores are missing. The aim of our study is to examine whether an intervention targeting pain catastrophizing mitigates the risk of chronic postsurgical pain and disability. Our primary hypothesis is that targeted perioperative cognitive behavioral therapy decreases the risk of chronic postsurgical pain and disability after spinal fusion surgery in high catastrophizing patients. Methods We will perform a two-center prospective, single-blind, randomized, controlled study comparing lumbar spinal fusion surgery outcome between 2 cohorts. Adult patients selected for lumbar spinal fusion with decompression surgery and a minimum score of 24 on the pain catastrophizing scale will be randomized with 1:1 allocation for either perioperative cognitive behavioral therapy (intervention group) or a perioperative education plus progressive exercise program (control group). Patients randomized to the intervention group will receive six individual sessions of cognitive behavioral therapy, two sessions before the operation and four after. Primary outcome is the Core Outcome Measures Index at 12 months. Secondary outcomes include pain, disability, depression and quality of life. Discussion This is the first trial that evaluates the effectiveness of cognitive behavioral therapy as a perioperative tool to improve pain and disability after spinal fusion surgery in comparison with an educational/exercise control intervention, in patients with high levels of pain catastrophizing. If perioperative cognitive behavioral therapy proves to be effective, this might have important clinical implications, reducing the incidence of chronic postsurgical pain and improving outcome after spinal fusion surgery. Trial registration Clinicaltrials (NCT03969602). Registered 31 May 2019,

scholarly journals A Mobile Phone–Based App for Use During Cognitive Behavioral Therapy for Adolescents With Anxiety (MindClimb): User-Centered Design and Usability Study (Preprint)

2020 ◽  
Author(s):  
Amanda Newton ◽  
Alexa Bagnell ◽  
Rhonda Rosychuk ◽  
Janelle Duguay ◽  
Lori Wozney ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Clinical Care ◽  
Phase 1 ◽  
Average Score ◽  
High Fidelity ◽  
Heuristic Evaluation ◽  
Phase 2 ◽  
Phase 3 ◽  
System Usability

BACKGROUND Mobile device–based tools to help adolescents practice skills outside of cognitive behavioral therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. OBJECTIVE This study aimed to develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, a smartphone-based app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. METHODS This 3-phase study took place from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, we conducted 2 high-fidelity testing sessions using the think-aloud approach (acceptability, learnability, usability) and 10-item System Usability Scale with 10 adolescents receiving CBT. The high-fidelity MindClimb app was evaluated by 5 app developers based on Nielsen’s usability heuristics and 5-point severity ranking scale. In phase 3, a total of 8 adolescents and 3 therapists assessed the usability of MindClimb during CBT sessions by recording the frequency of skills practice, use of MindClimb features, satisfaction with the app, and barriers and facilitators to app use during treatment. RESULTS Feedback from phase 1 consultations indicated that the app should (1) be responsive to user needs and preferences, (2) be easy to use and navigate, (3) have relevant content to the practice of CBT for anxiety, and (4) be aesthetically appealing. Using this feedback as a guide, a fully functional app prototype for usability testing and heuristic evaluation was developed. In phase 2, think-aloud and usability data resulted in minor revisions to the app, including refinement of exposure activities. The average system usability score was 77 in both testing cycles, indicating acceptable usability. The heuristic evaluation by app developers identified only minor errors (eg, loading speed of app content, with a score of 1 on the severity ranking scale). In phase 3, adolescents considered app features for completing exposure (6.2/10) and relaxation (6.4/10) modestly helpful. Both adolescents (average score 11.3/15, SD 1.6) and therapists (average score 10.0/12, 2.6 SD) reported being satisfied with the app. CONCLUSIONS The user-centered approach to developing and testing MindClimb resulted in a mobile health app that can be used by adolescents during CBT for anxiety. Evaluation of the use of this app in a clinical practice setting demonstrated that adolescents and therapists generally felt it was helpful for CBT practice outside of therapy sessions. Implementation studies with larger youth samples are necessary to evaluate how to optimize the use of technology in clinical care and examine the impact of the app plus CBT on clinical care processes and patient outcomes.

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