Ward, S., Donovan, H., Gunnarsdottir, S., Serlin, R.C., Shapiro, G.R., & Hughes, S. (2008). A randomized trial of a representational intervention to decrease cancer pain (RIDcancerPain). Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 27(1), 59–67.

To determine if the changes associated with the RIDcancerPain program—in regard to beliefs, coping, pain severity, and pain-related interference—are greater than the changes associated with standard education

Subjects were randomized to the control group or the intervention group. The control group received attention and standardized information about pain. Information was basic. The control group received a booklet, in question-answer format, that provided a review of common misconceptions about pain and information about managing the side effects of opioids. The intervention consisted of one session. Coverage of each subject during the session lasted 20–60 minutes. Patients were asked to describe beliefs about cancer pain (cause, timeline, consequences, cure, and control). The intervener identified and discussed misconceptions, provided accurate information, and cited the benefits of implementing changes based on the information provided. Patients discussed misconception-related limitations and losses. After the intervention (2–3 days later), patients in the intervention group had the opportunity to ask questions and provide comments via telephone, in a conversation with the research nurse. Patient-related baseline measures were gathered by means of self-report questionnaires that had been mailed to the patient prior to the intervention. Measures were also gathered at 1 and 2 months.

• The sample was composed of 176 patients.
• Mean patient age was 55.11 years (SD = 11.52 years).
• Of all patients, 57.4% were female and 42.6% were male.
• The most frequent diagnoses were breast, gastrointestinal, genitourinary, and gynecologic cancers. Of all patients, 64.8% did not have health problems other than cancer; 40.9% were receiving concomitant chemotherapy. Of all patients, 71% were married and 86.9% were Caucasian. Mean severity of pain at baseline was 4.17 on a 10-point scale.

• Multisite
• Outpatient clinic in Wisconsin

Randomized controlled trial

• Brief Pain Inventory (selected items relating to pain severity, pain-related interference with life, and beliefs about analgesic use)
• Pain management index in regard to adequacy of analgesic use (a Likert-type scale, 0–3, for rating usual pain during the past week)
• Quality of Life Index-Cancer Version

• Compared to patients in the control group, patients in the intervention group showed greater decreases in barriers across time (p = 0.0025), with an effect size (d) of 0.765. In the intervention group, barriers decreased from baseline to the first follow-up month but then increased between the first- and second-month follow-ups.
• There was a greater decrease in usual pain severity for patients in the intervention group (p = 0.0085). No other main effects in analysis of variance were shown in regard to the intervention.
• Both groups of subjects showed decreased barriers over time.
• Changes in pain severity and quality of life varied over time.
• Of all patients, 21% dropped out of the study after completion of baseline measures. Dropouts had higher pain severity than did others.
• Approximately 50% of subjects had adequate pain control according to severity measures at the time of study entry. Analysis of mediators of pain variables was inconclusive, demonstrating different apparent correlations at different points in time.

The RIDcancerPain intervention reduced measured patient barriers to pain management and usual pain severity but demonstrated no effect on other measures of pain severity, coping, pain-related interference with life, or overall well-being.

• The study had a risk of bias due to no appropriate control group. The attentional control group did not receive the follow-up telephone  calls that the intervention group received.
• Authors provided no information about changes in analgesic regimen or other pain management approaches.
• One-tailed tests of significance were used. This is a procedure consistent with the directional hypothesis posed, but it makes achievement of statistical significance more likely.
• Authors provided no analysis of difference in subgroups of patients, based on adequacy of background pain control.

Findings suggest that providing the information specified in the RIDcancerPain program can be beneficial in terms of overcoming known barriers to effective pain management. However, the effect of the program on overall pain control remains unclear: Findings suggest that time and attention may be the most important factors in dealing with barriers to pain management. (In the intervention group, the period in which effects were greatest was shortly after individualized sessions and follow-up calls.)