Effectiveness of a Training Program in Improving Coping Skills in People With Arthritis Pain

OA affects approximately 60 percent of people older than 65 and can cause significant pain
and impairment in functioning. Biomedical treatments are limited in their ability to curb OA
disease progression and to eliminate pain and functional impairment. Consequently,
health-related quality of life is often significantly impaired in people with arthritis. In
academic research settings, pain coping skills training (CST) for arthritis improves the
negative physical and social effects of OA. However, CST is not available to the vast
majority of OA patients. Proving that CST is equally successful in community medical
settings might make it more available to patients receiving care in these settings. Nurses
with training in patient education are likely to be well-suited to deliver CST. This study
will determine the effectiveness of CST for reducing arthritis pain when it is administered
by nurse practitioners and registered nurses in community medical settings.

Participants in this study will be randomly assigned to either take part in a 10-session CST
program for chronic pain or receive usual care. Participants in the treatment program will
attend sessions in their doctor's offices. A nurse practitioner or registered nurse will
meet with each participant for approximately 45 minutes each week to teach methods for
management of pain associated with OA. Some of the strategies will include relaxation
training, managing activity cycles, and changing thought patterns to reduce the negative
effects of pain. Some sessions may be conducted on the phone rather than in person. All
sessions will be tape-recorded for quality assurance purposes. Participants will be asked to
practice coping skills between visits. At the end of the last visit, participants will spend
an additional 60 minutes completing a booklet of questions about their health, pain levels,
and response to the treatment program. Participants assigned to the usual care group will
continue to see their healthcare providers as they normally would. They will not meet with
the nurse or receive the CST. Assessments of pain, physical and psychological disability,
self-efficacy, pain coping skills, and quality of life will be conducted for all
participants pre-treatment, post-treatment, and at 6-month and 1-year follow-ups.

Inclusion Criteria:

- Patient in one of the two recruitment community clinics

- Diagnosis of knee or hip OA

- History of pain greater than or equal to a 4 on a 10-point scale for at least 6
months prior to study entry

- Able to read, write, and understand English

- Absence of significant psychiatric or cognitive dysfunction

- Able to attend 10 treatment sessions

- Access to telephone to complete interactive voice response (IVR) ratings and possible
phone sessions

- Completion of baseline assessment

Exclusion Criteria:

- Scheduled for joint replacement surgery within the 18 months following study entry