Pain Clinical Trial
Official title:
Feasibility and Efficacy of a Mindfulness-enhanced Positive Affect Induction for Experimentally Induced Pain
Verified date | March 2023 |
Source | University of Colorado, Denver |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The goal of this clinical trial is to test if a mindfulness-enhanced positive affect induction (MPAI) works well to reduce pain intensity and pain unpleasantness from a cold water pain test in undergraduate college students who do not endorse ongoing medical or mental health diagnoses. The main questions it aims to answer are: - Is the MPAI a feasible and acceptable psychological technique for managing brief pain? - Does the MPAI work well to reduce pain intensity and unpleasantness from experimentally induced brief pain, compared to those using a breathing meditation or those instructed to respond naturally. - Does using the MPAI work well to improve confidence in self-managing brief pain? Participants will be asked to complete questionnaires about their sleep, pain beliefs, and emotions after consenting to participate and at the end of the study session. They will then be randomized to either: - Use the MPAI for managing pain induced by a cold water test (placing their hand in a container of cold water kept at approximately 5 degrees Celsius). - Use a breathing meditation for managing pain induced by a cold water test (placing their hand in a container of cold water kept at approximately 5 degrees Celsius). - Respond naturally to pain induced by a cold water test (placing their hand in a container of cold water kept at approximately 5 degrees Celsius). Researchers will compare the MPAI group to the breathing meditation and natural response groups to see if the MPAI group reports less pain from the cold water test and
Status | Completed |
Enrollment | 180 |
Est. completion date | November 14, 2022 |
Est. primary completion date | November 14, 2022 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years to 65 Years |
Eligibility | Inclusion Criteria: - University of Colorado Students - Age 18-65 - Fluent in written and spoken English Exclusion Criteria: - Presence of an untreated mood or psychiatric disorder - Presence of a current chronic pain condition - Presence or history of Reynaud's syndrome, peripheral neuropathy, or unstable heart condition (including myocardial infarction, abnormal heart rhythms, or hypertension) - Current use of prescription pain medication, high-dose anti-psychotics, selective serotonin re-uptake inhibitors (SSRIs), benzodiazepines, or gabapentin - Day-of over the counter pain medication use - Marijuana, Cannabidiol (CBD), or psilocybin use within three days of study participation (recency of use assessed via self-report) - Food, caffeine, and nicotine are not to be had within 30 minutes of cold pressor test (nicotine patch not exclusionary due to stable/consistent state). |
Country | Name | City | State |
---|---|---|---|
United States | University of Colorado Denver | Denver | Colorado |
Lead Sponsor | Collaborator |
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University of Colorado, Denver |
United States,
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Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Demographics | A general demographics form will be used to obtain information regarding participant age, gender, race/ethnicity, and socioeconomic status (SES). | Demographics will be assessed during the baseline survey set | |
Other | Positive and Negative Affect (past 7 days), assessed by PANAS | Positive and negative affect from the previous seven days will be assessed via the Positive and Negative Affect Schedule (PANAS). The PANAS assesses overall positive affect (PA) and negative affect (NA) across 20 items (10 positive affect and 10 negative affect), with high internal consistency (0.88 PA, 0.85 NA), convergent validity (.89 - .95) and divergent validity (-.02 - -.18). Temporal instruction will be specific to past week (e.g., "Please indicate the extent to which you have felt this way during the past week"), to assess for the influence of recent affect states on the relationship between affect induction and cold pressor test (CPT) outcomes. Item responses are rated on a 1-4 four-point scale ranging from "very slightly or not at all" to "very much". Example positive affect (PA) items include: enthusiastic, inspired, and interested. Example negative affect (NA) items include: nervous, ashamed, and afraid. | The PANAS will be assessed during the baseline survey set | |
Other | Pain Catastrophizing, assessed by the PCS | Pain catastrophizing will be assessed via the Pain Catastrophizing Scale (PCS). The PCS assesses negative mental states experienced during or in anticipation of a painful event (e.g., "I feel I can't stand it anymore" and "I can't seem to keep it out of my mind"). The PCS assesses pain catastrophizing across 13 items and three domains (rumination, magnification, and helplessness). It has been shown to have high internal consistency across subscales with alphas of 0.87 (total PCS score), 0.87 (rumination), 0.66 (magnification), and 0.78 (helplessness). As pain catastrophizing has been shown to be associated with numerous pain-related outcomes, it is being collected to assess its influence on the relationship between affect induction and CPT outcomes. Items assess various thoughts surrounding the experience of pain. Item responses are rated on a 0-4 five-point scale, with anchors of "Not at all" to "All the time", with higher scores indicating higher pain catastrophizing. | The PCS will be assessed during the baseline survey set | |
Other | Sleep Quality (past 7 days), assessed by the SD-sf 8a | Sleep from the past seven days will be assessed via the PROMIS Sleep Disturbance - short form 8a (SD-sf 8a). The SD-sf 8a is a validated measure of sleep disturbance in the past seven days, with conventional reliability of approximately .90 and above for SD-sf-8a. Sleep from the past seven days will be collected to assess the influence of the previous week's sleep quality on the relationship between affect induction and CPT outcomes. Item responses are rated on a 1-5 five-point scale, with anchors ranging from "Not at all" to "Very much", "Never" to "Always", and "Very poor" to "Very good". Example items from the SD-sf 8a include: In the past seven days "My sleep was restless", "I had trouble staying asleep", and "I got enough sleep". Higher scores indicate worse sleep quality. | The SD-sf 8a will be assessed during the baseline survey set | |
Other | Mood States, assessed by the POMS-SF | The profile of mood states - short form (POMS-SF) is a 37-item questionnaire assessing six different mood states: tension, anger, depression, fatigue, vigor, and confusion. Instructions are for respondents to select the number that best describes how they feel "right now". Items are in a checklist format, in which adjectives for each of the six mood states are listed and rated on a 0-4 scale, with 0=Not at all, 1=A little, 2=Moderately, 3=Quite a bit, and 4=Extremely. The POMS-SF has been shown to have good internal consistency with Cronbach's alphas ranging between .76 (confusion) and .95 (depression) across the six mood state categories, as well good convergent validity with correlations of .63 with the Center for Epidemiologic Studies Depression (CES-D) Scale. Higher scores indicate higher intensity of a respective mood state. | The POMS-SF will be assessed during the baseline survey set | |
Other | Present moment anxiety, assessed by single anxiety rating | Present moment anxiety will be assessed via a single-item: "Please rate your current level of anxiety (related or unrelated to the study)". Item responses will be rated on a 1-5 five-point scale with anchors ranging from "None at all" to "Extreme anxiety". Present-moment anxiety will be collected to assess the influence of anxiety on the relationship between affect induction and CPT outcomes. Higher scores indicate higher intensity of anxiety. | Present moment anxiety will be assessed during the baseline survey set | |
Other | Meditation Experience | Meditation experience will be assessed via two items: "How many hours per week do you meditate?" and "Please describe your typical method of meditation". Number of hours per week will be provided via radio buttons ranging from "0" to "10+". Method of meditation will only be assessed if number of hours per week is greater than zero (via REDCap branching logic). Responses to method of meditation will be open-ended via a text box. Meditation experience will be collected to assess the influence of meditation experience on the relationship between affect induction and CPT outcomes, as the affect inductions do involve an aspect of formal meditation (e.g., focusing on the breath, bodily sensations, and emotions). | Meditation experience will be assessed during the baseline survey set | |
Other | Handedness | Handedness will be assessed via a single item: "Please record your handedness". Item responses will include "Right handed", "Left handed", and "Ambidextrous". The purpose of assessing handedness is to ensure the non-dominant hand is used for each CPT. | Handedness will be assessed during the baseline survey set | |
Primary | Pain Tolerance, assessed by duration of CPT | Pain tolerance will be assessed via the amount of time (i.e., number of seconds) until participants remove their hand from the cold water during the cold pressor test (CPT). CPT duration will be timed via a stopwatch and will begin when the participant's hand is submerged in the cold water up to the wrist and will stop immediately when the hand is removed. More time in the water will be indicative of greater pain tolerance. Water temperature will be maintained at 5 degrees Celsius to optimize potential for pain intensity and tolerance during the CPT measures. Longer duration of the CPT will indicate higher pain tolerance. | Pain tolerance, assessed by duration of the CPT, will be recorded immediately after the intervention (i.e., the CPT), during the post-CPT survey set | |
Primary | Pain Intensity, assessed by VAS | Pain intensity will be assessed via two items: "Please rate your peak pain intensity experienced during the cold water test" and "Please rate your average pain intensity experienced during the cold water test". Each item response will be rated on a 0-100 visual analog scale (VAS). "0" will indicate no pain intensity and "100" will indicate intolerable pain intensity, with higher scores indicating higher pain intensity. | Pain intensity will be collected immediately after the intervention (i.e., the CPT) during the post-CPT survey set. | |
Primary | Pain Unpleasantness, assessed by VAS | Pain unpleasantness will be assessed via two items: "Please rate your peak pain unpleasantness experienced during the cold water test (e.g., how bothersome you found the pain from the cold water test)" and "Please rate your average pain unpleasantness experienced during the cold water test (e.g., how bothersome you found the pain from the cold water test)". Each item response will be rated on a 0-100 visual analog scale (VAS). "0" will indicate no pain unpleasantness and "100" will indicate intolerable pain unpleasantness, with higher scores indicating higher pain unpleasantness. | Pain unpleasantness will be collected immediately after the intervention (i.e., the CPT) during the post-CPT survey set. | |
Primary | Feasibility beliefs of MPAI as implementable and efficacious for pain management, assessed by three PBQ items | Feasibility beliefs of MPAI in pain management will be assessed via three items from the Pain Beliefs Questionnaire (PBQ): "Would you be able to perform the coping strategy while in pain?", 2) "How well will you be able to focus your attention on the coping strategy while in pain?", 3) "How confident are you that you will be able to use the coping strategy to reduce your pain while in pain?". Item responses will be given on a 0-6 seven-point Likert scale with anchors varying by the item (e.g. Not at all Confident/Very Confident, Not at all Well/Very well, and Very Uncertain/Very Certain). Means and percentages will be calculated. Good feasibility with PBQ items will be considered by high mean percentage ratings (=80%) for each item, with higher mean percentages will indicating greater feasibility (see Outcome 6 below for detail on PBQ). Although the PBQ will be assessed at multiple time points, feasibility analyses will only include items assessed immediately after the intervention. | Feasibility measures (i.e., the PBQ) will be collected immediately after the intervention (i.e., the CPT) during the post-CPT survey set. | |
Primary | Acceptability of MPAI as a technique for reducing pain, assessed by six questions on satisfaction and usefulness of the MPAI | Acceptability will be assessed via the following items: "How acceptable did you find the coping strategy to be?", "How satisfied are you with the coping strategy?", "How useful was the coping strategy?", "Was the coping strategy easy to understand?", "Was the coping strategy easy to use?", "How likely are you to use the coping strategy you learned today?". Item responses will be given on a 0-6 seven-point Likert scale with anchors varying by the item (e.g. Not at all Acceptable/Very Acceptable, Not at all Satisfied/Very Satisfied, Not at all Useful/Very Useful, Extremely Difficult to Understand/Very Easy to Understand, Extremely Difficult to Use/Very Easy to Use, and Not at all Likely/Highly Likely). Means, standard deviations, and percentages of PBQ items will be calculated. Good acceptability will be considered by high mean percentage ratings (=80%) for each item, with higher mean percentages indicating greater acceptability. | Acceptability questions will be assessed immediately after the intervention (i.e., the CPT) during the post-CPT survey set. | |
Primary | Self-Efficacy in Pain Management assessed by change in Pain Beliefs Questionnaire (PBQ) total scores | Self-efficacy in pain management will be assessed via the Pain Beliefs Questionnaire (PBQ). The PBQ is a nine-item instrument assessing beliefs in ability to manage pain, as well as ability to learn and utilize a pain self-management technique, with high internal consistency (Chronbach's alpha = 0.89). Example items include: "The degree of pain I experience is mostly up to me" and "How well will you be able to focus your attention on the coping strategy while in pain?". Item responses are given on a 1-7 seven-point scale with anchors such as True/False, Agree/Disagree, Difficult/Easy, Very Little Control/Complete Control, Very Uncertain/Very Certain, Not at all Well/Very well, and Not at all Confident/Very Confident. Total PBQ scores are calculated as the mean of all nine items, with higher scores representing higher levels of self-efficacy in pain management | Self-efficacy in pain management, assessed by change in PBQ total scores will be assessed during the baseline survey set and the post-CPT survey set (i.e., immediately after the intervention) | |
Secondary | Present-Moment Affect, assessed by affect ratings | Present-moment affect will be assessed via single-item overall affect measures. The purpose for single-item measures is to capture general state affect, which may not be captured via the Positive and Negative Affect Schedule (PANAS). For example, although gratitude is an aspect of positive affect likely to be influenced by the affect induction, it is not an item directly captured with the PANAS. Present-moment affect ratings will be collected to assess manipulation checks of affect induction, as well as influences of present-moment affect on the relationship between affect induction and CPT outcomes. Positive affect will be assessed via the item: "Please rate the extent you currently feel positive emotion". Negative affect will be assessed via the item "Please rate the extent you currently feel negative emotion". Item responses will be rated on a 1-5 five-point scale ranging from "Very slightly or not at all" to "Very much", with higher scores indicating stronger affect. | Present-moment affect will be collected during baseline, before the CPT (after condition practice), immediately following the CPT | |
Secondary | Positive Affect Manipulation Check | A manipulation check for the positive affect induction will be assessed via a question asking: "Did you experience an increase in positive emotion during the meditation?". If "No" is selected, a follow-up question will prompt participants to select the following relevant factors/reasons, as is appropriate for them: "I am having a bad day/week", "I have experienced a negative life event related to the meditation topic", "I have experienced a negative life event unrelated to the meditation topic", "I am tired/have not slept well recently", "I was not able to focus on the meditation", "I am anxious or fearful about upcoming life events", "I am not in a good mood right now". This will be collected with those randomized to the mindfulness-enhanced positive affect induction (MPAI) and breathing meditation (BM) groups, as part of checking for sufficient practice with their respective meditations. | The positive affect manipulation check measure will be assessed pre-intervention [i.e., immediately after practice of the respective meditation, immediately before using the respective meditation during the cold pressor task (CPT)] |
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