Improving Access to Pain Treatment

Providing treatment to chronic pain patients living in rural areas and patients with limited mobility presents itself as a challenge.

Three studies presented during the American Pain Society’s 29th Scientific Conference focused on developing innovative treatment options to reach specific rural, low-income patients and disabled veterans:

Beverly Thorn, PhD ABPP, professor and chair of psychology at the University of Alabama, discussed her study on cognitive behavioral therapy versus educational attention therapy for rural chronic pain patients in Pine Apple, Alabama.

Thorn’s study focused on low-income rural Alabamian patients, a majority of which were female, unemployed, and suffered from low back pain, or arthritis. Among the innovative methods used were that the team, knowing the literacy level of the participants was at a very low level, decided to lower the reading of the distributed manuals from a 10th grade level to a fifth grade level. They also enhanced the text with illustrations so that the patient could create a visual image to compliment the learning process. The patients were given reading and homework assignments. Thorn said they wanted to make it simple for patients to understand and comfortable for them to work with, since there would be reading and written assignments.

“You also have to consider the cognitive load or demand of the treatment,” Thorn said.

The CBT portion discussed primary appraisals, assessed core beliefs, and introduced coping techniques like relaxation, while the educational group discussed the control theory of pain, how pain is communicated, and more.

Thorn found that the CBT group demonstrated a significant decrease in depression, they self reported, post-treatment, that they were able to let-go of their pain, and learned about self-efficacy. In the EDU group patients reported that they felt the information they learned was very valuable and learned to accept their pain.

Dawn Ehde, PhD associate professor in the department of rehabilitation Medicine at the University of Washington School of Medicine, discussed her study on telephone-delivered cognitive behavioral therapy interventions for patients experiencing pain from spinal cord injury, multiple sclerosis, and amputation.

The “Telephone Intervention for Pain Study,” (TIPS) aims to evaluate the efficacy of this type of intervention in adults with these specific pain conditions. Like Thorn’s study, TIPS is performed on two groups, one receiving CBT and the other receiving educational training (ED-T). All the training takes place over the phone, which remedies the common transportation problems these patients may face. The manuals given were offered in a variety of different forms as well, per request, (CD, PDFs, Large Print, etc.)

The average of participants was 55 and 58%were female. When these patients were questioned on treatment satisfaction, post-study the reported it at 8.1, on a 1 to 10 scale, with 10 being the most helpful. Additionally, 94% said they would recommend it, Ehde said. The therapeutic alliance was strong as well. Patients reported feeling a connection with their therapists.

Gabriel Tan, PhD ABBP, spoke about access to care for veterans that reside in rural areas, specifically female veterans suffering from chronic pain associated with traumas and depression.

Tan, a clinical health psychologist at the VA Medical Center in Houston, helped devise an experiment that would provide CBT and introduce the use of a Stress Eraser to help patients better cope with their pain. The SR is a portable biofeedback device that teaches users to breath at resonant frequency. The patients receive hands-on learning session on how to use the SR and a DVD program to assist them. The goal was to gradually practice breathing exercises and reach an improved level each day. While participants have enrolled and followed the protocol, the research team is still in the process of analyzing and collecting follow-up data. Results are not yet available.

Providing treatment to chronic pain patients living in rural areas and to disabled patients with limited mobility presents itself as a challenge for many practicing pain management professionals. Not only is the transportation factor a burden for many of the low income and disabled patients, but often times the literature and programs designed use language that may not connect with these patients.