Cognitive Behavioral Therapy for Diabetic Neuropathic Pain

Diabetic Peripheral Neuropathic Pain Clinical Trial

Official title: Cognitive Behavioral Therapy for Diabetic Peripheral Neuropathic Pain

Status Completed

Clinical Trial Summary

The purpose of this study is to evaluate the efficacy of a brief psychological intervention, cognitive-behavior therapy, for the management of persistent pain associated with diabetic peripheral neuropathic pain.

Clinical Trial Description

Research Design: A randomized controlled design will be employed in which CBT plus standard pharmaceutical care (CBT/SC) is compared to an educational intervention plus standard pharmaceutical care (ED/SC) treatment condition. A target sample size of approximately 215 participants will be recruited. Participants will be randomized in equal numbers to the two conditions.

Methodology: Study participants will be evaluated pre-treatment (baseline), 12 weeks post-baseline (post-treatment) and at 36 weeks post-baseline (follow-up). Baseline assessment will include a physical examination to confirm the diagnosis of diabetic neuropathy. The primary outcome measure will be pain intensity. Secondary outcome measures will be pain quality, pain-related disability, and physical and emotional functioning. Measures of treatment feasibility will also be examined. CBT and ED will be provided in 10 weekly, individual treatment sessions of 60 minutes. The effectiveness of the randomization process will be tested by examining potential between condition differences on important demographic and pain-relevant descriptive variables, as well as on the dependent measures. Analyses of covariance will be employed to determine whether statistically significant differences in the two treatment conditions are observed at the 12- and 36-week intervals controlling for pretreatment/baseline scores on these same measures and other covariates identified previously.

Hypotheses Treatment outcome hypotheses

• Persons with DPNP receiving cognitive behavioral therapy with standard pharmaceutical care (CBT/SC), relative to those receiving diabetic education with standard pharmaceutical care (ED/SC), will demonstrate, immediately following treatment improvements on several measures of the experience of persistent pain, including pain intensity, pain quality, pain-related disability, sleep quality, physical functioning, and emotional functioning, and they will have fewer added pain medication doses and concomitant pain treatments.

• Persons with DPNP receiving CBT/SC, relative to those receiving ED/SC, will demonstrate maintenance of these benefits at a 36-week post-baseline follow-up period.

Treatment satisfaction and feasibility hypotheses

• Persons with DPNP receiving CBT/SC, relative to those receiving ED/SC, will demonstrate, immediately following treatment higher ratings of treatment credibility and treatment satisfaction, and higher rates of treatment session attendance and lower rates of treatment dropout.

Exploratory secondary analyses of predictors of treatment participation and outcome

• Increased readiness to adopt a self-management approach will be positively associated with higher ratings of treatment credibility and treatment satisfaction, higher rates of treatment session attendance and lower rates of treatment dropout, and for participants in the CBT condition only, higher rates of adherence to therapist recommendations for pain coping skill practice and other intersession goals.

• Increased readiness to adopt a self-management approach over the course of treatment will be associated with improved outcomes following treatment.

• Increased readiness to adopt a self-management approach at treatment termination will significantly predict maintenance of treatment benefits on follow-up.

• Persons with medical and psychiatric comorbidities will demonstrate, relative to those without these comorbidities, less improved outcomes, lower rates of treatment session attendance and higher rates of treatment dropout, and for the CBT condition only, lower rates of adherence to therapist recommendations for pain coping skill practice and other intersession goals. ;

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Diabetic Neuropathies
• Diabetic Peripheral Neuropathic Pain
• Neuralgia

• NCT number: NCT00829387
• Study type: Interventional
• Source: VA Connecticut Healthcare System
• Status: Completed
• Phase: N/A
• Start date: March 2010
• Completion date: December 2013