- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04118283
Assessment and Treatment for Chronic Pain in Veterans With Serious Mental Illness (CPSMI)
Improving the Assessment and Treatment of Chronic Pain in Veterans With Serious Mental Illness
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This research study will address critical gaps in our understanding and management of chronic musculoskeletal pain in Veterans with serious mental illness (SMI), addressing the following aims:
Aim 1: Complete a pilot randomized controlled trial (RCT) with 45 Veterans with co-occurring SMI and chronic musculoskeletal pain to examine feasibility and acceptability of CBT-CP and preliminarily evaluate participant responses to intervention.
Aim 1a (Primary): Determine feasibility by demonstrating adequate rates of recruitment and completion of and fidelity to the CBT-CP intervention as well as quality and acceptability of chosen assessments.
Aim 1b (Primary): Determine acceptability by obtaining favorable ratings from satisfaction questionnaires and interviews.
Aim 1c (Exploratory): Preliminarily evaluate participant responses to intervention by exploring changes in functioning and quality of life among Veterans randomized to the CBT-CP condition (n=30).
Aim 2: Determine the feasibility of collecting EMA data to examine the temporal relationships among mental health symptoms, pain severity, and health-related functioning. Data will be collected at baseline from the 45 Veterans in the Aim 1 RCT.
Aim 2b (Primary): Determine feasibility of this approach through adherence to the EMA call schedule and overall response rates.
Aim 2a (Exploratory): Explore relationships among mental health symptoms, pain severity, and health-related functioning captured in real time.
Aim 3: Complete a well-specified process evaluation to explore how to optimize CBT-CP for use in Veterans with SMI and chronic musculoskeletal pain in future clinical trials. This evaluation will integrate qualitative data from 15 interviews with Veterans in the CBT-CP condition, CBT-CP interventionist notes, and quantitative data from Aims 1 and 2.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Letitia Travaglini, PhD
- Phone Number: (410) 605-1867
- Email: Letitia.Travaglini@va.gov
Study Locations
-
-
Maryland
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Baltimore, Maryland, United States, 21201
- Recruiting
- Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD
-
Contact:
- Letitia Travaglini, PhD
- Phone Number: 410-605-1867
- Email: Letitia.Travaglini@va.gov
-
Principal Investigator:
- Letitia Travaglini, PhD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Have a chronic musculoskeletal pain diagnosis
- Have a Defense and Veterans Pain Rating Scale (DVPRS) rating of 4 or greater for pain severity
- Meet criteria for an SMI diagnosis (schizophrenia, schizoaffective disorder, bipolar disorder) per medical record
- 18 years of age or older
- Enrolled in outpatient programming within the VA Maryland Health Care System at time of consent/study renrollment
- Have regular access to a telephone
- Capacity to sign informed consent
Exclusion Criteria:
- Are engaging in moderate-to-severe substance use that would impact their ability to participate and/or would require a higher level of care (as determined by treating provider)
- Engagement in Cognitive Behavioral Therapy for Chronic Pain (CBT-CP), whether currently or in the past
- Have a current acute pain condition or limited mobility (i.e., unable to walk one city block) that would interfere with their ability to engage in CBT-CP interventions (e.g., activity pacing/walking program)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Cognitive Behavioral Therapy for Chronic Pain
Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) will be conducted in accordance with the Cognitive Behavioral Therapy for Chronic Pain: Therapist Manual and the VA Evidence-Based Practice (EBP) roll-out training.
CBT-CP consists of a 12-session protocol, including an initial assessment session (BL assessment; Session 1), 10 content-specific sessions (pain education, goal-setting, cognitive and behavioral skill building; Sessions 2-11), and a booster session scheduled approximately one month after the final CBT-CP session (Session 12).
Participants randomized to the CBT-CP condition (n = 30) will complete one 60-minute individual session per week.
Each CBT-CP session will be led by a trained study interventionist using a manualized curriculum, following a basic structure including review of previous session material, introduction of new information or skills, and discussion of how to implement learned material into a home action plan.
|
Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) will be conducted in accordance with the Cognitive Behavioral Therapy for Chronic Pain: Therapist Manual and the VA Evidence-Based Practice (EBP) roll-out training.
CBT-CP consists of a 12-session protocol, including an initial assessment session (BL assessment; Session 1), 10 content-specific sessions (pain education, goal-setting, cognitive and behavioral skill building; Sessions 2-11), and a booster session scheduled approximately one month after the final CBT-CP session (Session 12).
Participants randomized to the CBT-CP condition (n = 30) will complete one 60-minute individual session per week.
Each CBT-CP session will be led by a trained study interventionist using a manualized curriculum, following a basic structure including review of previous session material, introduction of new information or skills, and discussion of how to implement learned material into a home action plan.
Other Names:
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Active Comparator: Health and Wellness
Health & Wellness was developed by VISN 5 MIRECC investigators and consists of psychoeducation on topics related to physical and emotional wellbeing.
Its structure is similar to CBT-CP (10 weekly individual 60-minute sessions, no booster session).
Each Health & Wellness session will be led by a trained interventionist using a manualized curriculum that includes review of previous session material, introduction of new information, and discussion of a range of health-related topics (physical activity/exercise, nutrition/healthy eating, managing medications and side effects, and addictive behaviors (e.g., substance use, gambling, eating) that do not include pain.
Typical sessions include discussion of the impact of the topic on overall health and well-being, identifying benefits and challenges to improving or maintaining health in that area, and strategies to address challenges in that area.
|
Health & Wellness was developed by VISN 5 MIRECC investigators and consists of psychoeducation on topics related to physical and emotional wellbeing.
Its structure is similar to CBT-CP (10 weekly individual 60-minute sessions, no booster session).
Each Health & Wellness session will be led by a trained interventionist using a manualized curriculum that includes review of previous session material, introduction of new information, and discussion of a range of health-related topics (physical activity/exercise, nutrition/healthy eating, managing medications and side effects, and addictive behaviors (e.g., substance use, gambling, eating) that do not include pain.
Typical sessions include discussion of the impact of the topic on overall health and well-being, identifying benefits and challenges to improving or maintaining health in that area, and strategies to address challenges in that area.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Participant Satisfaction Questionnaire (CSQ-8)
Time Frame: Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
The CSQ-8 contains eight Likert scale items that ask about quality of service received and if services have been helpful.
Scores on the CSQ-8 range from 8 (lowest) to 32 (highest).
This measure will be used to assess CBT-CP acceptability (Aim 1b).
|
Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
Service Satisfaction Scale (SSS-30)
Time Frame: Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
The SSS-30 has 30 items that assess practitioner manner and skill, perceived outcome, office procedures, and accessibility.
An overall score ranges from 30 (lowest) to 150 (highest).
This measure will be used to assess CBT-CP acceptability (Aim 1b).
|
Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) Feasibility
Time Frame: Data will be gathered from each participant through intervention completion, an average of 10 weeks
|
To examine feasibility, engagement and participation in CBT-CP will be tracked across four key objectives: 1) evaluation of recruitment and suitability of eligibility criteria (# consented divided by # approached; # randomized divided by # consented); 2) retention and adherence rates based on the percent who engaged in treatment (% of randomized who attend first 3 sessions) and mean number of sessions attended and treatment dropout percentages (# who dropped out prior to completing treatment divided by # who engaged); 3) outreach efforts (mean number of reminders and outreach contacts made for each participant); and 4) the mean (and SD) number of completed CBT-CP homework assignments, assessed weekly by CBT-CP interventionists.
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Data will be gathered from each participant through intervention completion, an average of 10 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
West Haven-Yale Multidimensional Pain Inventory (WHYMPI) - Intereference
Time Frame: Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
The West Haven Yale Multidimensional Pain Inventory (WHYMPI) is a 52-item questionnaire providing a comprehensive assessment of components of the chronic pain experience that are helpful for the cognitive-behavioral conceptualization of chronic pain conditions.
Each item is rated on a 7-point scale.
The interference subscale will be used in this study and measures the impact of pain on functioning (household chores, outdoor work, recreation activities, social activities).
An average score is calculated that ranges from 0 (no interference) to 6 (extreme interference).
The WHYMPI has been used with a wide range of chronic pain populations and is sensitive to change following rehabilitative interventions.
The WHYMPI is used as part of the CBT-CP assessment protocol.
|
Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
Veterans RAND 36-item Health Survey (VR-36)
Time Frame: Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
The Veterans RAND 36-Item Health Survey (VR-36) is a 36-item questionnaire measuring health-related quality of life and 8 domains of health-related functioning (physical functioning, role limitations due to physical problems, role limitations due to emotional problems, bodily pain, general health perceptions, vitality, social functioning, and mental health).
Items are scored on a 3- to 6-point scale and are summed to create each of the domain scores, ranging from 0 (worst health status) to 100 (best health status).
The VR-36 demonstrated improved reliability, precision, and validity compared to the SF-36 and among persons with SMI.
|
Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)
Time Frame: Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
The WHODAS 2.0 is a 36-item questionnaire assessing health and disability across physical diseases and mental health disorders in both clinical and non-clinical settings and populations.
Items are scored on a 5-point scale ranging from 0 (no difficulty) to 4 (extreme difficulty/cannot do) and are summed to create total (ranging from 0 to 144) and domain scores: understanding and communicating (ranging from 0 to 28); Getting around (ranging from 0 to 20); self-care (ranging from 0 to 16); getting along with people (ranging from 0 to 20); life activities (ranging from 0 to 32); and participating in society (ranging from 0 to 32).
Higher scores for each domain indicate greater disability.
Psychometric properties are excellent, with high internal consistency, test-retest reliability, a stable factor structure, good concurrent validity, and good sensitivity to change.
|
Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
World Health Organization Quality of Life Scale (WHOQOL-BREF)
Time Frame: Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
The World Health Organization Quality of Life Scale (WHOQOL-BREF) is a 26-item questionnaire assessing four domains of quality of life: physical health, psychological well-being, quality of social relationships, and environmental quality.
Items use different anchors but are rated on a scale from 1 to 5. Mean scores are calculated for each domain and then transformed to range from 0 (poorest quality of life) to 100 (best quality of life).
Psychometric properties of the WHOQOL-BREF are excellent, with demonstrated high internal consistency, discriminant validity, and construct validity for general, mental health, and physical health populations.
The WHOQOL-BREF is used as part of the CBT-CP assessment protocol.
|
Participants will be assessed following completion of the study intervention, an expected average of 10 weeks
|
West Haven-Yale Multidimensional Pain Inventory (WHYMPI) - Intereference
Time Frame: Participants will be assessed a second time following completion of the study intervention, an expected average of 22 weeks.
|
The West Haven Yale Multidimensional Pain Inventory (WHYMPI) is a 52-item questionnaire providing a comprehensive assessment of components of the chronic pain experience that are helpful for the cognitive-behavioral conceptualization of chronic pain conditions.
Each item is rated on a 7-point scale.
The interference subscale will be used in this study and measures the impact of pain on functioning (household chores, outdoor work, recreation activities, social activities).
An average score is calculated that ranges from 0 (no interference) to 6 (extreme interference).
The WHYMPI has been used with a wide range of chronic pain populations and is sensitive to change following rehabilitative interventions.
The WHYMPI is used as part of the CBT-CP assessment protocol.
|
Participants will be assessed a second time following completion of the study intervention, an expected average of 22 weeks.
|
Veterans RAND 36-item Health Survey (VR-36)
Time Frame: Participants will be assessed a second time following completion of the study intervention, an expected average of 22 weeks.
|
The Veterans RAND 36-Item Health Survey (VR-36) is a 36-item questionnaire measuring health-related quality of life and 8 domains of health-related functioning (physical functioning, role limitations due to physical problems, role limitations due to emotional problems, bodily pain, general health perceptions, vitality, social functioning, and mental health).
Items are scored on a 3- to 6-point scale and are summed to create each of the domain scores, ranging from 0 (worst health status) to 100 (best health status).
The VR-36 demonstrated improved reliability, precision, and validity compared to the SF-36 and among persons with SMI.
|
Participants will be assessed a second time following completion of the study intervention, an expected average of 22 weeks.
|
World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)
Time Frame: Participants will be assessed a second time following completion of the study intervention, an expected average of 22 weeks.
|
The WHODAS 2.0 is a 36-item questionnaire assessing health and disability across physical diseases and mental health disorders in both clinical and non-clinical settings and populations.
Items are scored on a 5-point scale ranging from 0 (no difficulty) to 4 (extreme difficulty/cannot do) and are summed to create total (ranging from 0 to 144) and domain scores: understanding and communicating (ranging from 0 to 28); Getting around (ranging from 0 to 20); self-care (ranging from 0 to 16); getting along with people (ranging from 0 to 20); life activities (ranging from 0 to 32); and participating in society (ranging from 0 to 32).
Higher scores for each domain indicate greater disability.
Psychometric properties are excellent, with high internal consistency, test-retest reliability, a stable factor structure, good concurrent validity, and good sensitivity to change.
|
Participants will be assessed a second time following completion of the study intervention, an expected average of 22 weeks.
|
World Health Organization Quality of Life Scale (WHOQOL-BREF)
Time Frame: Participants will be assessed a second time following completion of the study intervention, an expected average of 22 weeks.
|
The World Health Organization Quality of Life Scale (WHOQOL-BREF) is a 26-item questionnaire assessing four domains of quality of life: physical health, psychological well-being, quality of social relationships, and environmental quality.
Items use different anchors but are rated on a scale from 1 to 5. Mean scores are calculated for each domain and then transformed to range from 0 (poorest quality of life) to 100 (best quality of life).
Psychometric properties of the WHOQOL-BREF are excellent, with demonstrated high internal consistency, discriminant validity, and construct validity for general, mental health, and physical health populations.
The WHOQOL-BREF is used as part of the CBT-CP assessment protocol.
|
Participants will be assessed a second time following completion of the study intervention, an expected average of 22 weeks.
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Letitia Travaglini, PhD, Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD
Publications and helpful links
General Publications
- Birgenheir DG, Ilgen MA, Bohnert AS, Abraham KM, Bowersox NW, Austin K, Kilbourne AM. Pain conditions among veterans with schizophrenia or bipolar disorder. Gen Hosp Psychiatry. 2013 Sep-Oct;35(5):480-4. doi: 10.1016/j.genhosppsych.2013.03.019. Epub 2013 Apr 29.
- Stewart MO, Karlin BE, Murphy JL, Raffa SD, Miller SA, McKellar J, Kerns RD. National dissemination of cognitive-behavioral therapy for chronic pain in veterans: therapist and patient-level outcomes. Clin J Pain. 2015 Aug;31(8):722-9. doi: 10.1097/AJP.0000000000000151.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- D3069-W
- 1IK2RX003069-01A2 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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