UA Research Seeks to Reduce Literacy Barriers in Treating, Managing Pain

TUSCALOOSA, Ala. — The University of Alabama has been approved for a $1.27 million research award from the Patient-Centered Outcomes Research Institute to study different psychosocial treatments for the management of chronic pain.

Dr. Beverly E. Thorn, chair of UA’s psychology department, will lead the research project. The UA project will focus on reducing disparities in the management of chronic pain by adapting two psychosocial treatments to reduce literacy barriers often encountered by individuals with lower educational attainment.

All patients will continue receiving medical treatment as usual, with a third of the patients receiving additional pain education and a third receiving cognitive-behavioral therapy (skills for managing the stress associated with having chronic pain). Chronic pain affects more than 116 million Americans, costs $600 billion annually and is unequally borne by people in low-income brackets, especially ethnic minorities, said Thorn.

“Just like someone with diabetes, chronic pain is a chronic illness without a cure, and it has to be managed,” said Thorn. “Someone with diabetes cannot simply take insulin or other medication without changing their daily habits (wiser food choices, engaging in physical activity, and learning to manage stress). Someone with chronic pain cannot simply have multiple surgeries and take multiple medications without learning pain self-management skills. If someone learns to manage their own chronic condition better, that person will have fewer visits to the emergency department, will need fewer surgical interventions, and will feel the need to take less medication. These positive outcomes have already been demonstrated with research.”

Many individuals also have health literacy deficits, such as difficulty understanding their illness and difficulty navigating the health care system for treatment, Thorn said. These deficits place these individuals at a disadvantage in seeking and receiving adequate care. In addition, treatment for chronic pain usually relies on expensive medical interventions with negative side effects. Psychosocial treatments like Pain Education and Cognitive-Behavioral Therapy, or CBT, show promise but usually are unavailable or poorly adapted to the needs of people with lower educational attainment or lower health literacy.

“We are simplifying the patient materials and the treatment itself to make it easier for all patients to understand and incorporate into their lives,” Thorn said. “We think this will be particularly useful for patients with pain and low literacy.

“This award will allow us to continue our program of research showing initial effectiveness of health literacy-adapted pain education and CBT groups for chronic pain in a population with low income and low health literacy,” Thorn added. “We will build upon an ongoing partnership with Whatley Health Services, a federally qualified health consortium that serves the highly disadvantaged Black Belt region of West Alabama. The ultimate goal is to support the widespread use of these psychosocial treatments in community settings, in order to offer the best care available and reduce health care disparities for people with chronic pain.”

The project is part of a program of patient-centered comparative clinical effectiveness research that addresses the institute’s National Priorities for Research and Research Agenda. The Patient-Centered Outcomes Research Institute is committing $40.7 million in funding for a slate of 25 projects, which were approved by its board of governors following a competitive, multi-stage review process involving scientists, patients, caregivers and other stakeholders. Proposals were evaluated on the basis of scientific merit, engagement of patients and stakeholders, methodological rigor and fit within the institute’s National Priorities for Research and Research Agenda.

The awards were part of PCORI’s  first cycle of primary research funding and selected from among nearly 500 completed applications submitted earlier this year. All proposals were approved pending a business and programmatic review by staff and completion of a formal award contract.

“Today marks a major milestone in our work as we build a portfolio of comparative clinical effectiveness research that will provide patients and those who care for them better information about the health care decisions they face,” says Dr. Joe Selby, PCORI executive director. “These research projects reflect PCORI’s patient-centered research agenda, emphasizing the inclusion of patients and caregivers at all stages of the research.”

For more information about PCORI’s Funding Announcements, visit www.pcori.org/funding-opportunities.

The department of psychology is part of UA’s College of Arts and Sciences, the University’s largest division and the largest liberal arts college in the state. Students from the College have won numerous national awards including Rhodes Scholarships, Goldwater Scholarships and memberships on the USA Today Academic All American Team.