Randomized trial of group cognitive-behavioral therapy compared to a pain education control for low literacy rural people with chronic pain

Chronic pain is a common and costly experience. Cognitive-behavioral therapies (CBT) are efficacious for an array of chronic pain conditions. However, the literature is based primarily on urban (white) samples. It is unknown whether CBT works in low-socioeconomic (SES), minority and non-minority groups. To address this question, we conducted a Randomized Controlled Trial within a low-SES, rural chronic pain population. Specifically, we examined the feasibility, tolerability, acceptability, and efficacy of group CBT compared to a group education intervention (EDU). We hypothesized that while both interventions would elicit short- and long-term improvement across pain-related outcomes, the cognitively-focused CBT protocol would uniquely influence pain catastrophizing. Mixed design ANOVAs were conducted on the sample of eligible participants who did not commence treatment (N=26), the intent-to-treat sample (ITT; N=83), and on the completer sample (N=61). Factors associated with treatment completion were examined. Results indicated significantly more drop-outs occurred in CBT. ITT analyses showed that participants in both conditions reported significant improvement across pain-related outcomes, and a nonsignificant trend was found for depressed mood to improve more in CBT than EDU. Results of the completer analyses produced a similar pattern of findings; however, CBT produced greater gains on cognitive and affect variables than EDU. Treatment gains were maintained at 6-month follow-up (N=54). Clinical significance of the findings and the number of treatment responders is reported. Overall, these findings indicate CBT and EDU are viable treatment options in low-SES, minority and non-minority groups. Further research should target disseminating and sustaining psychosocial treatment options within underserved populations.