Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial

Beth D Darnall, Maisa S Ziadni, Anuradha Roy, Ming-Chih Kao, John A Sturgeon, Karon F Cook, Kate Lorig, John W Burns, Sean C Mackey, Beth D Darnall, Maisa S Ziadni, Anuradha Roy, Ming-Chih Kao, John A Sturgeon, Karon F Cook, Kate Lorig, John W Burns, Sean C Mackey

Abstract

Background: The Institute of Medicine (IOM) reported that chronic pain affects about 100 million U.S. adults, with chronic low back pain (CLBP) cited as the most prevalent type. Pain catastrophizing is a psychological construct shown to predict the development and trajectory of chronic pain and patient response to pain treatments. While effective treatment for pain catastrophizing typically includes eight-session groups of cognitive behavioral therapy (CBT), a single-session targeted treatment class yielded promising results which, if replicated and extended, could prove to efficiently and cost-effectively reduce pain catastrophizing. In this trial, we seek to determine the comparative efficacy of this novel single-session pain catastrophizing class to an eight-session course of pain CBT and a single-session back pain health education class. We will also explore the psychosocial mechanisms and outcomes of pain catastrophizing treatment.

Methods: In this trial we will randomize 231 individuals with CLBP to one of three treatment arms: (1) pain-CBT (eight weekly 2-h group sessions with home exercises and readings); (2) a single 2-h pain catastrophizing class; or (3) a single 2-h back pain health education class (active control). For the primary outcome of pain catastrophizing, the trial is designed as a non-inferiority test between pain-CBT and the single-session pain catastrophizing class, and as a superiority test between the single-session pain catastrophizing class and the health education class. Team researchers masked to treatment assignment will assess outcomes up to six months post treatment.

Discussion: If the single-session targeted pain catastrophizing class is found to be an effective treatment for patients with CLBP, this low cost and low burden treatment could dismantle many of the current barriers and burdens of effective pain care. Further, elucidation of the mechanisms of pain catastrophizing treatments will facilitate future research on the topic as well as further development and refinement of treatments.

Trial registration: ClinicalTrials.gov, NCT03167086 . Registered on 22 May 2017.

Keywords: Back pain; Chronic pain; Cognitive behavioral therapy; Pain catastrophizing; Psychology; Treatment.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by Stanford’s Institutional Review Board (protocol no. 34631), 3000 El-Camino Real, Five Palo Alto Square, 4th Floor, Palo Alto, CA 94306, USA. We are obtaining informed consent from all participants in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of the trial protocol
Fig. 2
Fig. 2
The schedule of enrollment, interventions, and assessments

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