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Davis, Melinda

Psychology

2006

MA

Chronic pain afflicts 33% of the American population and amounts to between $100 and $149.4 billion in associated annual costs. Previous studies indicate that multidimensional programs such as cognitive behavioral therapy (CBT) are efficacious treatments for chronic pain. However, despite the initial success of these programs many patients experience declines in therapeutic benefits over time. As such, the University of Vermont (UVM) MindBody Medicine Clinic developed a Therapeutic Interactive Voice Response (TIVR) system to be used following the completion of group therapy. This system was designed to reinforce pain coping skills learned in group CBT and to prevent chronic pain relapse behaviors. The present thesis analyzes archival data collected between February 2003 and July 2004 via the TIVR system. After 11 weeks of group CBT for chronic musculoskeletal pain at the MindBody Medicine Clinic, 23 individuals were trained to use the TIVR system daily for four months. Daily data from the TIVR self-monitoring reports were analyzed with the SAS linear mixed models procedure to address the three study aims. These aims were 1) to explore the general associations between the self monitored variables, 2) to explore the impact of practice frequency on the self monitored variables, and 3) to explore the impact of relaxation practice on the self monitored variables and to determine if the use of relaxation techniques as a coping strategy was associated with reductions in pain independent of the other coping strategies used.
Patient self-reports of pain, stress, coping, and catastrophizing were all significantly correlated. After controlling for time, reductions in stress and catastrophizing were associated with reductions in pain. Increased self-reports of coping were associated with reductions in pain. Call frequency was significantly associated with reductions in stress when considered by week and showed marginally significant associations with increased coping across the entire study period. Increased reports of the total number of coping strategies utilized per daily call were associated with self-reported reductions in stress and increases in coping. Most interestingly, frequency of relaxation practice was associated with same day reductions in stress and pain as well as increases in coping. Daily relaxation practice was highly associated with the use of relaxation techniques as a coping strategy in response to stress or pain. Reported use of relaxation techniques as a coping strategy was robustly associated with reductions in same day pain levels independent of the other coping skills used. The present thesis improves on previous studies' methodologies through the analysis of daily data as patients learn to cope with chronic musculoskeletal pain following group CBT. Real time relationships between the self-reported variables of stress, coping, and catastrophizing on pain yield insight into the dynamic nature of the coping process and skill acquisition. Furthermore, relaxation practice and the application of relaxation techniques as a coping strategy are revealed to be important dimensions in successfully coping with chronic pain following group CBT.