{
  "abstract": "Background Trauma exposure is prevalent among individuals with chronic pain and is associated with poorer pain-related outcomes. Brief, scalable interventions that target overlapping trauma-pain processes are needed. This single-arm pilot study evaluated feasibility, acceptability, and changes in clinical outcomes following Stress, Trauma, and Emotional Processing for Pain (STEPP), a brief modified version of emotional awareness and expression therapy.Methods Adults (N=42) with mixed-etiology chronic pain and trauma exposure were enrolled. STEPP was delivered remotely over three weekly 1-hour individual sessions. Participants completed questionnaires at baseline, post-treatment, and 1-month, and 3-month follow-up. Feasibility benchmarks (≥70%) were prespecified for recruitment, treatment, and follow-up completion. Acceptability was assessed using the Treatment Helpfulness Questionnaire (THQ; −5 to 5) and Credibility and Expectancy Questionnaire (content credibility and expected benefit; 3–27). Linear mixed models and Hedges’ g effect sizes examined changes in pain intensity (0–10) and interference with functioning (0–100), post-traumatic stress disorder symptoms (PTSD; 0–80), pain catastrophizing (concerns about pain; 0–52), and kinesiophobia (fear of movement; 17–68).Results All feasibility benchmarks were met. 93% of eligible participants enrolled, 90% of enrolled participants initiated treatment, and 97% initiators completed treatment. Among completers, follow-up completion was 100% at post-treatment and 97% at 1 and 3 months. THQ ratings were high and met benchmarks (post M=4.0±1.2; 1-month M=3.9±1.2; 3-month M=3.8±1.3). Credibility ratings met benchmarks, whereas expectancy ratings did not. Significant improvements were observed from baseline to post-treatment: pain intensity (mean change=−0.64, SE=0.23, 95% CI −1.11 to −0.18), pain interference (−3.34, SE=0.84, 95% CI −5.00 to −1.68), PTSD (−5.60, SE=1.53, 95% CI −8.64 to −2.57), pain catastrophizing (−6.69, SE=1.34, 95% CI −9.34 to −4.03), and kinesiophobia (−5.78, SE=1.21, 95% CI −8.19 to −3.37); changes were maintained through 3 months. Effect sizes were small for pain intensity and moderate-to-large for all other outcomes.Conclusions STEPP demonstrated feasibility and acceptability, with promising improvements in pain-related and trauma-related outcomes. Randomized controlled trials are needed to establish efficacy.",
  "authors": [
    {
      "affiliations": [
        "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Chestnut Hill, Massachusetts, USA",
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Jolin B Yamin"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Chestnut Hill, Massachusetts, USA",
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Jenna M Wilson"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "John A Sturgeon"
    },
    {
      "affiliations": [
        "Department of Psychology, Wayne State University, Detroit, Michigan, USA"
      ],
      "name": "Mark A Lumley"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Chestnut Hill, Massachusetts, USA"
      ],
      "name": "Michaela Sawada"
    },
    {
      "affiliations": [
        "Harvard Medical School, Boston, Massachusetts, USA",
        "Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Pamela Rist"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Chestnut Hill, Massachusetts, USA",
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Robert R Edwards"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Chestnut Hill, Massachusetts, USA",
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Samantha M Meints"
    }
  ],
  "title": "Pilot study of feasibility, acceptability, and changes in clinical outcomes following a brief trauma-focused intervention for chronic pain",
  "uid": "c4a202c8-c952-50fa-8e0f-1a2ebc7f7959"
}