Heterogeneity of Treatment Effects in a Randomized Trial of Literacy-Adapted Group Cognitive-Behavioral Therapy,Pain Psychoeducation,and Usual Medical Care for Multiply Disadvantaged Patients With Chronic Pain |
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| Affiliation: | 2. Department of Behavioral Science, Rush University Medical Center, Chicago, Illinois;3. Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois;4. Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama;2. Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health Mannheim, University of Heidelberg, Mannheim, Germany;3. Schaller Research Group on Neuropeptides, German Cancer Research Center DKFZ, Heidelberg, Germany;2. Glia Institute, Ribeirao Preto, Sao Paulo, Brazil;3. Purdue Pharma, Purdue Pharma, USA;2. Department of Psychology, University of La Verne, La Verne, California;3. Department of Psychology, University of Notre Dame, Notre Dame, Indiana;4. Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina;5. Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois;2. Department of Anesthesia and Pain Medicine, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada;3. Department of Anaesthesia, Addenbrooke''s Hospital, Cambridge, UK;4. Addenbrooke''s Centre for Clinical Investigation (GlaxoSmithKline), Cambridge, UK;2. Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, California |
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| Abstract: | Differences among patients can moderate the impact of evidence-based treatments (ie, heterogeneity of treatment effects), leading patients to get more or less benefit. The Learning About My Pain study was a randomized, comparative effectiveness trial of a 10-week literacy-adapted group cognitive-behavioral therapy for chronic pain (CBT) versus pain psychoeducation groups (EDU) versus usual medical care. We examined potential sociodemographic and cognitive moderators of treatment effect among participants with post-treatment assessments (N = 241). Analyses were conducted using moderation in the PROCESS macro in SPSS and significant interactions were explored further. Education and primary literacy moderated the difference between CBT and EDU on pain intensity, and primary literacy, health literacy, and working memory moderated the difference between CBT and EDU on pain interference. Analyses revealed few significant moderation effects relative to usual medical care. No moderators were identified for depression. Neither sex nor minority status moderated any differences between groups. Patients with lower education, literacy, and working memory gained more benefit from CBT than EDU. When provided sufficient guidance and structure in a way that is meaningfully adapted, highly disadvantaged patients achieved as much benefit as less disadvantaged patients, suggesting that the literacy-adapted CBT more successfully met the needs of this population.Trial registrationclinicaltrials.gov identifier NCT01967342PerspectiveThis article presents findings related to heterogeneity of treatment effects for simplified group psychosocial treatments for chronic pain. The results suggest that educationally, cognitively, or literacy disadvantaged patients benefit most from the more structured approach of literacy-adapted CBT rather than EDU, whereas less disadvantaged patients benefit from either treatment. |
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