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Chronic Low Back PainNCT03658226

Case Series Evaluation of Psychodynamic Interpersonal Therapy in Chronic Low Back Pain

A study testing Psychodynamic Interpersonal Therapy (PIT) in people with Chronic Low Back Pain, run by Charlotte Morgan at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Many people in the world have chronic pain; this is pain which lasts more than twelve weeks. Pain can cause people to feel low in mood and change how they feel about themselves and others around them. Therapy for chronic pain does not always work and often people do not have lasting effects from treatment. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Chronic Low Back Pain
What is being tested?
Psychodynamic Interpersonal Therapy (PIT)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
8 participants
Where
1 siteUnited Kingdom
Study dates
19 Sep 2018to 9 Sep 2019
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Previously attended the Walton Centre pain management programme (PMP).
  • Treatment resistant; six months after PMP treatment still experiencing clinically significant pain measured as 5+ on the pain distress rating scale. IMMPACT recommendations advise the use of numerical rating scales (NRS) in clinical trials of chronic pain treatments (Dworkin et al., 2005).
  • Classified as "interpersonally distressed" on the West Haven Yale Multidimensional Pain Inventory (WHYMPI).
  • Able to converse in English proficiently which is a requirement given the conversational nature of therapy.
  • Able to commit to treatment and willing to be randomly allocated to baseline.

Who cannot join

  • Other comorbid degenerative conditions and cancers.
  • Psychosis
  • History of prior suicide attempts.
  • Active plans of self-harm and/or suicide.

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • The Walton Centre NHS Foundation Trust

    Liverpool, L9 7LJ

Other trials in United Kingdom

About this study

Official title: A Case Series Evaluation of Psychodynamic Interpersonal Therapy (PIT) in Chronic Low Back Pain (CLBP) Patients

Many people in the world have chronic pain; this is pain which lasts more than twelve weeks. Pain can cause people to feel low in mood and change how they feel about themselves and others around them. Therapy for chronic pain does not always work and often people do not have lasting effects from treatment. This study hopes to see if a different therapy, called Psychodynamic Interpersonal Therapy (PIT), can help people with chronic pain. This therapy looks at how we see ourselves and our relationships with others; it aims to help people address personal problems that make it difficult for them to manage their pain.

The study aims to show that PIT is a suitable treatment for chronic low back pain and that people will have fewer problems with their mood, how they feel about themselves and their relationships. This study will give people with chronic low back pain eight sessions of PIT and during therapy they will fill in forms about their pain, mood, relationship problems and how they feel about themselves. We will also look at practical things to do with the therapy (e.g. how many sessions people came to, reasons for stopping therapy etc.) and ask people about how they felt about the therapy they had. Three months after the study has finished, people will be asked to fill in the forms again to see if the effects have lasted.

This research could help to give people with chronic pain a new and different treatment option which has good and lasting effects.

Read the detailed description

Chronic pain is continuous, long-term pain of more than 12 weeks. Patients with chronic pain are a heterogeneous group with varied pathologies (e.g. osteoarthritis; fibromyalgia) and pain sites (e.g., chronic low back pain, CLBP; chronic widespread pain). Chronic pain affects more than two fifths of the UK population, that is, around 28 million adults. Currently, the biopsychosocial model of pain is the most widely used heuristic approach to understanding chronic pain. The biopsychosocial perspective recognises that pain emerges from a dynamic interplay of a patient's physiological state, thoughts, emotions, behaviours, and sociocultural influences. This acknowledges that pain is a subjective experience and treatment approaches are aimed at management, rather than cure, of chronic pain.

Chronic pain affects social, psychological and emotional wellbeing. Current psychological treatments (e.g. CBT and ACT) aim to support patients to cope with the impact of chronic pain and improve their quality of life. However, some critical questions remain regarding the effectiveness of these interventions. Research indicates that substantial numbers of patients do not benefit greatly from these approaches and often effects are not maintained across time. Audit data from a local Pain Management Programme (PMP) indicates that many patients remain distressed by pain after treatment, with approximately 80% scoring 5 or more out of 10 on a pain distress scale six months later. Thus, it appears that current psychological therapies are not targeting all relevant issues.

Evidence indicates that psychodynamic therapies show some efficacy in the treatment of chronic pain, demonstrating patterns of change in interpersonal problems, pain intensity and depression-anxiety. Interpersonal literature states that aspects of relating are implicated in chronic pain; for example, perceived burdensomeness (feeling a burden on others) and thwarted belongingness (loneliness and feeling alienated from others) are significantly associated with pain intensity, self-efficacy and functional limitations.

Psychodynamic Interpersonal Therapy affirms that our sense of self and ability to relate to others are important determinants of how able we are to regulate emotion, manage adversity and access social support. As such, they are likely to play a fundamental role in how we cope with chronic pain. Studies have found an association between insecure attachment and related interpersonal difficulties with poor pain self-efficacy, anxiety and poor coping. Therefore, a psychological therapy such as PIT which focuses on addressing negative relationship patterns and strengthening sense of self may be of value in the treatment of chronic pain.

Psychological interventions such as PMPs seek to address the role of relationships and social networks in self-management of pain but do not target the psychological issues underlying interpersonal problems. Where individuals report high levels of interpersonal difficulties, a more in-depth focus on these issues may be required. As PIT seeks to understand how problematic patterns of relating are contributing to a person's distress and maladaptive coping, it may be a helpful approach. A clinical example of this is a person whose pain is exacerbated by overactivity related to their inability to say no to other's demands (e.g. for fear of upsetting them or eliciting conflict and rejection). Additionally, PIT has many strengths as an approach; it is a short, manualised and evidence-based treatment which has previously demonstrated promising results in the treatment of other conditions characterised by disabling chronic pain such as multisomatoform functional syndromes disorder and irritable bowel syndrome.

Presently, the efficacy of PIT in chronic pain is unknown. With that in mind, the proposed study seeks to conduct an evaluation of the acceptability, feasibility and efficacy of PIT in a chronic pain population; treatment resistant CLBP. The outcome of this study has the potential to inform future therapeutic options for those with chronic pain. The results may support the use of an alternative 1:1 therapy for those with interpersonal difficulties as it follows that they would require a treatment for chronic pain which has an interpersonal focus.

The primary aim of this study is to conduct a preliminary evaluation of whether PIT is an acceptable and feasible therapy for patients with treatment resistant CLBP (where patients are still experiencing clinically significant pain following previous treatment) and interpersonal difficulties. This will be measured using adherence to therapy and patient satisfaction and acceptability measures.

The secondary aim is to conduct an initial evaluation of the efficacy of PIT in people with treatment resistant CLBP and interpersonal problems, including its impact on pain distress, self -efficacy, and interpersonal functioning.

Being tested
Psychodynamic Interpersonal Therapy (PIT)
Keywords
Case Series, Acceptability, Feasibility, Psychodynamic Interpersonal Therapy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Psychodynamic Interpersonal Therapy (PIT)Behavioural

    PIT is conversational model of psychotherapy; participants will receive 8 sessions of this therapy once weekly. The first session will be 2 hours and all remaining sessions will be 50 minutes.

Study groups in NCT03658226
Study groupRoleWhat they receive
TherapyExperimentalPsychodynamic Interpersonal Therapy (PIT)
Receives: Behavioral: Psychodynamic Interpersonal Therapy (PIT)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Objective measure of behaviour 1 - Number of sessions attended

    Measuring feasibility/acceptability of therapy

    Measured: Measured at the end of therapy (at week 8).

  2. Satisfaction questionnaire (PIT for CLBP)

    Measuring acceptability of therapy (face validity). A self-reported measure of satisfaction regarding the content of the therapy. A questionnaire has been devised based on the theoretical framework of acceptability in Sekon, Cartwright \& Francis (2017). There are two versions for post session one and post session eight with slightly different wording. This outcome measure will assess change.

    Measured: Administered twice in the 8 weeks of therapy after session 1 (week 1) and Session 8 (week 8); the first and last sessions of therapy.

  3. Measure of adverse reactions

    A quantitative measure containing a list of anticipated/likely adverse reactions (e.g. exacerbation of pain, feeling more upset than usual, increased problems in relationships) and unanticipated/adverse reactions. It is expected that therapy may increase emotional symptoms in the short term as the participants make realisations within therapy. This is a tick box measure with a qualitative 'other' box for further input.This outcome measure will assess change.

    Measured: Participants will complete this before each therapy session weekly and it will be discussed with the therapist/PI in session. As therapy is for 8 weeks, participants will complete this once weekly for eight weeks.

  4. Objective measure of behaviour 2 - Completion rate from therapy

    Measuring feasibility/acceptability of therapy

    Measured: Measured at the end of therapy (at week 8).

Secondary outcomes (5)
  1. Chronic Pain Acceptance Questionnaire-8 (CPAQ-8)

    CPAQ-8 - Fish, R. A., McGuire, B., Hogan, M., et al. (2010) A short version of the CPAQ and consists of eight items which measures pain acceptance and distress.

    Measured: During baseline (no therapy) this will be completed weekly for a minimum of 3 weeks and a maximum of 6 weeks (dependent on randomised baseline group). All participants will complete the measure weekly during therapy for 8 weeks.

  2. Pain Self Efficacy Questionnaire (PSEQ)

    PSEQ Nicholas, M. K (2007). The PSEQ assesses confidence in performing activities whilst in pain and beliefs about coping with pain.

    Measured: During baseline (no therapy) this will be completed weekly for a minimum of 3 weeks and a maximum of 6 weeks (dependent on randomised baseline group). All participants will complete the measure weekly during therapy for 8 weeks.

  3. The Interpersonal Needs Questionnaire for Pain (INQ-P)

    INQ-P (Methley et al. 2017). A measure of interpersonal factors in chronic pain adapted from the INQ; assesses thwarted belongingness and perceived burdensomeness specific to chronic pain.

    Measured: During baseline (no therapy) this will be completed weekly for a minimum of 3 weeks and a maximum of 6 weeks (dependent on randomised baseline group). All participants will complete the measure weekly during therapy for 8 weeks.

  4. The Beck Depression Inventory (BDI)

    BDI (Beck et al. 1961). The BDI is recommended as a core outcome measure of emotional functioning in chronic pain clinical trials (Dworkin at al., 2005).

    Measured: During baseline (no therapy) this will be completed weekly for a minimum of 3 weeks and a maximum of 6 weeks (dependent on randomised baseline group). All participants will complete the measure weekly during therapy for 8 weeks.

  5. Daily clinical measure (4 questions)

    Four single item measures were generated using literature on interpersonal difficulties in chronic pain. All questions may be scored from 0-5; 0 being 'Not at all' and 5 being ' As good as I can feel/Extremely'.

    1. "How distressing has your pain been today?"
    2. "How lonely have you felt today?"
    3. "How good have you felt about your relationships with other people today?"
    4. "How good have you felt about yourself today?" Item 1 is based on generic numerical rating scales used to measure pain distress.

    Item 2 is a measure of social distress that we would expect to be amenable to change via PIT; it is an important outcome that overlaps with but is not the same as depression.

    Items 3 and 4 measure variables that PIT is designed to target and which we might expect to mediate any improvement in the other outcomes. Item 3 links with social connection (i.e., belongingness) and item 4 with perceived burdensomeness since how you feel about yourself influences whether you see yours.

    Measured: During baseline (no therapy) answered daily for a minimum of 3 weeks and a maximum of 6 weeks (dependent on randomised baseline group). All participants will answer them daily during therapy for 8 weeks.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Sep 2018
  2. Study start19 Sep 2018
  3. Primary completion29 Mar 2019
  4. Study completion9 Sep 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
A series of experimental single case studies comparing individual CLBP participants' clinical outcomes during a baseline phase (receive no treatment) with those during a treatment phase (receive 8 sessions of PIT). Clinical outcomes will be the impact of treatment on pain distress/intensity, self-efficacy, mood and interpersonal functioning. There will be repeated measurement (daily/weekly) of the outcomes during baseline and intervention phases, to assess real-time change in these variables on a case-by-case basis. We will vary the length of the baseline phase randomly across participants, who will commence treatment following 3, 4, 5 or 6 weeks. This "multiple baselines" design will allow us to establish whether any improvement in clinical outcomes is caused by the intervention rather than natural change over time. We will assess feasibility/acceptability of the intervention by recording adverse reactions, side effects, adherence and participants' views about the intervention.
Masking
None (open label)
Enrolment
8 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03658226
Sponsor's protocol ID
NHS001382
Status last verified
Sep 2019
First submitted
23 May 2018
Last updated
25 Sep 2019
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Participants will be required to consent to their anonymised outcome data (clinical measures and feasibility/acceptability measures) being used in similar research studies conducted at the University of Manchester.

Questions about this trial

What is this clinical trial studying?

A study testing Psychodynamic Interpersonal Therapy (PIT) in people with Chronic Low Back Pain, run by Charlotte Morgan at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Sep 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Objective measure of behaviour 1 - Number of sessions attended (time frame: Measured at the end of therapy (at week 8).). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Sep 2019.

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