In African American patients with osteoarthritis (OA), pain coping skills training (CST) improved pain coping abilities and management perceptions, but not pain severity, according to a report published in Pain.
Despite disproportionate OA pain and dysfunction, African American patients in the United States suffer from underrepresentation in trials examining cognitive and behavioral pain interventions. Investigators sought to gain more perspective on the cultural appropriateness of such therapeutic tools, hypothesizing that pain CST would significantly improve outcomes in this patient population.
Between May 2016 and August 2017, the parallel-group, randomized controlled Pain Coping Skills Training for African Americans with Osteoarthritis trial (ClinicalTrials.gov identifier: NCT02560922) enrolled 248 African American participants with hip or knee OA, placed in either a treatment group consisting of 11 weekly CST sessions (n=124; mean age, 59.2 years; 49.2% women; mean symptom duration, 12.4 years) or a waitlist control group (n=124; mean age, 58.9 years; 49.2% women; mean symptom duration, 13.6 years). The primary outcome was the 3-month Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscore. Secondary outcomes included 9-month WOMAC pain results with 3- and 9-month assessments using multiple validated measures of patient pain, coping, management, and perception. Linear mixed modeling was used to evaluate between-group differences.
Of the 248 participants, 92% completed the 3-month follow-up assessments (CST, 89%; waitlist, 94%), and 85% completed the 9-month follow-up (CST, 79%; waitlist, 90%). There was a mean of 8.0 CST sessions completed by treatment group patients.
The 3-month WOMAC pain subscale scores demonstrated no significant differences from baseline between groups (difference, −0.63; 95% CI, −1.45 to 0.18; P =.128), and the 9-month WOMAC pain scores showed similar nonsignificant results (difference, −0.84; 95% CI, −1.73 to 0.06; P =.068). Regarding secondary end points, the CST group saw significant differences in Total Coping Attempts on the Coping Strategies Questionnaire (3 months, P <.001; 9 months, P <.001), Pain Catastrophizing Scale scores (3 months, P =.008), Arthritis Self-Efficacy Scale scores (3 months, P <.001; 9 months, P =.02), and Patient Global Assessment of Pain Change scores (P <.001 for both points).
Study strengths included a multicenter design, inclusion of more men than other studies, proactive participant recruitment, inclusion of veterans, and maintenance assessments using extended follow-up time.
Study limitations included self-reported racial categorization, lack of radiographic OA confirmation, lack of cultural adaptation impact assessment, absence of comparison with a generic CST program, lack of CST fidelity ratings, and inclusion of mostly well-educated patients from a single geographic area.
“We believe these findings support the value of efforts to disseminate pain CST among
African Americans with OA, as a part of overall efforts to mitigate racial disparities in OA-related outcomes,” noted the authors. They recommended that future research explore adherence enhancement and treatment response factors while considering pain CST cost-effectiveness.
Allen KD, Somers TJ, Campbell LC, et al. Pain coping skills training for African Americans with osteoarthritis [published online February 19, 2019]. Pain. doi:10.1097/j.pain.0000000000001525