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Effect of a Positive Psychological Intervention on Pain and Functional Difficulty Among Adults With OsteoarthritisA Randomized Clinical Trial

Educational Objective
To answer the question, Is positive psychology effective as a treatment for chronic arthritis pain and does it reduce race disparities in pain management?
1 Credit CME
Key Points

Question  Is positive psychology effective as a treatment for chronic arthritis pain and does it reduce race disparities in pain management?

Findings  In this randomized clinical trial involving 360 Veterans Affairs patients with chronic pain from osteoarthritis, a 6-week telephone-administered positive psychological intervention did not improve pain or functional difficulty vs a control program. No difference by race was found in the effect of the intervention.

Meaning  A telephone-administered positive psychological intervention was not associated with improvement in chronic pain or functional difficulty from osteoarthritis for either white or African American patients.

Abstract

Importance  Positive psychological interventions for improving health have received increasing attention recently. Evidence on the impact of such interventions on pain, and racial disparities in pain, is limited.

Objective  To assess the effects of a positive psychological intervention on pain and functional difficulty in veterans with knee osteoarthritis.

Design, Setting, and Participants  The Staying Positive With Arthritis Study is a large, double-blinded randomized clinical trial powered to detect race differences in self-reported pain in response to a positive psychological intervention compared with a neutral control intervention. Data were collected from 2 urban Veterans Affairs medical centers. Participants included non-Hispanic white and non-Hispanic African American patients aged 50 years or older with a diagnosis of osteoarthritis. Mailings were sent to 5111 patients meeting these criteria, of whom 839 were fully screened, 488 were eligible, and 360 were randomized. Enrollment lasted from July 8, 2015, to February 1, 2017, with follow-up through September 6, 2017.

Interventions  The intervention comprised a 6-week series of evidence-based activities to build positive psychological skills (eg, gratitude and kindness). The control program comprised similarly structured neutral activities. Programs were delivered via workbook and weekly telephone calls with interventionists.

Main Outcomes and Measures  The primary outcomes were self-reported pain and functional difficulty measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range 0-100). Secondary outcomes included affect balance and life satisfaction.

Results  The sample included 180 non-Hispanic white patients and 180 non-Hispanic African American patients (mean [SD] age, 64.2 [8.8] years; 76.4% were male). Mean (SD) baseline scores for WOMAC pain and functional difficulty were 48.8 (17.6) and 46.8 (18.1), respectively. Although both decreased significantly over time (pain: χ23 = 49.50, P < .001; functional difficulty: χ23 = 22.11, P < .001), differences were small and did not vary by treatment group or race. Exploratory analyses suggested that the intervention had counterintuitive effects on secondary outcomes.

Conclusions and Relevance  The results of this randomized clinical trial do not support the use of positive psychological interventions as a stand-alone treatment for pain among white or African American veterans with knee osteoarthritis. Adaptations are needed to identify intervention components that resonate with this population, and the additive effect of incorporating positive psychological interventions into more comprehensive pain treatment regimens should be considered.

Trial Registration  ClinicalTrials.gov Identifier: NCT02223858

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Article Information

Accepted for Publication: July 12, 2018.

Published: September 21, 2018. doi:10.1001/jamanetworkopen.2018.2533

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2018 Hausmann LRM et al. JAMA Network Open.

Corresponding Author: Leslie R. M. Hausmann, PhD, Center for Health Equity Research and Promotion, Veterans Affair Pittsburgh Healthcare System, University Drive (151C-U), Pittsburgh, PA 15240 (leslie.hausmann@va.gov).

Author Contributions: Drs Hausmann and Youk had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Hausmann, Kwoh, Gallagher, Ibrahim.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Hausmann, Youk, Gallagher, Ibrahim.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Youk, Obrosky.

Obtained funding: Hausmann, Ibrahim.

Administrative, technical, or material support: Hausmann, Kwoh, Mauro, McInnes, Ibrahim.

Supervision: Hausmann, Kwoh, Ibrahim.

Conflict of Interest Disclosures: Dr Gallagher was the National Director for Pain Management in the Veterans Health Administration until November 1, 2016. There was no involvement of his duties in this role with the research study. Dr Kwoh reported receiving grants and personal fees from EDM Serono, grants from Abbvie, and personal fees from Astellas, Fidia, and Thuane outside the submitted work. Dr Hausmann reported receiving grants from the Department of Veterans Affairs during the conduct of the study. No other disclosures were reported.

Funding/Support: This work was supported by grant IIR13-080 from the Veterans Health Administration Health Services Research and Development Service (principal investigator: Dr Hausmann). Dr Ibrahim was supported in part by grant K24AR055259 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr Vina was supported in part by grant K23AR067226 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The views expressed here are those of the authors and do not represent those of the Department of Veterans Affairs, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institutes of Health, or the US government.

Additional Contributions: Kaitlyn Gerlowski, BS (Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania), Aliya Collier, MSOD (University of Pennsylvania, Philadelphia), Chasity Young, MPH (Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia), Dennis Miller, BS (Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia), Kaushal Desai, BA, MPH (University of Pennsylvania, Philadelphia), Claire Canestrino (University of Pennsylvania, Philadelphia), Kristianna Desmarais, BS (Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia), and others assisted with data collection; these individuals were compensated for their contributions. Acacia Parks, PhD (Department of Psychology, Hiram College, Hiram, Ohio, and Happify, New York, New York), provided conceptual input on the intervention and study design and for commenting on an earlier draft of this article. Dr Parks was compensated for her contributions.

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