Background/Purpose:  African Americans (AAs) bear a disproportionate burden of osteoarthritis (OA), with greater pain and disability compared with Non-Hispanic Whites.  Pain coping skills training (PCST) is a promising intervention to reduce racial disparities in OA-related pain and other outcomes, but there has been little study of PCST among AAs.  This project engaged AAs with OA and other stakeholders (caregivers, clinicians) to culturally tailor a PSCT program for AAs, then evaluated the PCST program in a multi-site randomized controlled trial. 

Methods:  248 AAs (51% male, mean age = 29 years) with knee OA were randomized with equal allocation to PCST and wait list (WL) control groups.  The PCST program involved 11 telephone-based sessions over 12 weeks, delivered by a counselor.  Outcomes were assessed at baseline, 12 weeks and 36 weeks and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (primary outcome), WOMAC total score (pain, stiffness and function), Coping Strategies Questionnaire (CSQ) – Total Coping Attempts, Pain Catastrophizing Scale (PCS), PROMIS Pain Interference Scale, Patient Health Questionnaire (PHQ-8, depressive symptoms), and Arthritis Self-Efficacy Scale.  Linear mixed models were fit for all outcomes with unstructured covariance to account for repeated measurements. All models included stratification variables (enrollment site and gender).

Results:  At 12-week follow-up, the PCST group improved (decreased) in WOMAC pain score more than the WL group, but the difference was not statistically significant (Table 1).  At 12-week follow-up there were significant differences, in favor of the PCST group, for CSQ Total Coping Attempts, PCS, and Arthritis Self Efficacy (p<0.01).  At 36 weeks, WOMAC pain scores were significantly improved in the PCST group compared with the WL group (p<0.05, Table 1).  CSQ Total Coping Attempts and Arthritis Self Efficacy scores were also significantly improved at 36 weeks in the PCST group, compared with the WL group (p<0.01).

Conclusion: The culturally tailored PCST program resulted in improved pain severity, particularly at longer-term follow-up, and pain coping among AAs with knee OA.  Other studies also suggest that effects of PCST interventions may be more robust after patients have had more opportunity to practice and incorporate skills.  Dissemination of this PCST program may help to reduce racial disparities in pain.