Using mixed methods case-series evaluation in the development of a guided self-management hybrid CBT and ACT intervention for multiple sclerosis pain

Abstract

Purpose: Two-thirds of the people with multiple sclerosis (pwMS) experience pain. Medications provide minimal relief, and current non-pharmacological interventions lack a clear conceptualization of MS pain. This study explored the potential efficacy of a telephone-supported hybrid cognitive behavior therapy and acceptance and commitment therapy self-management intervention for pwMS based on an empirically supported model of MS pain using a replicated single-case series design.

Methods: Seven pwMS with varied demographic and disease characteristics completed the 8-week home-based program alongside 3 hours of telephone support. Online questionnaires were completed every four days for 16 weeks (4-weeks baseline, 8-weeks treatment, 4-weeks follow-up). The primary outcomes were pain severity and pain interference. Psychological process variables drawn from the MS pain model were also completed, and post-treatment qualitative interviews conducted.

Results: Simulation modeling analysis (SMA) showed three patients had large improvements in pain outcomes, two showed no change and two worsened. Five participants showed significant change on various psychological process variables. Change in pain catastrophizing was the most consistent finding.

Conclusions: The findings suggest a self-management program for MS pain with minimal therapy support may be effective for some pwMS, but not those with more complex comorbidities. The participants suggested web-based delivery may simplify the approach, and therapist telephone contact was highly valued.

Implications for Rehabilitation

• This case series suggests a hybrid CBT/ACT self-management workbook program for MS pain improves severity and impact of pain in some pwMS.

• Pain-related catastrophizing reduced in most pwMS, whilst change in other ACT and CBT process variables varied across the individuals.

• PwMS feedback suggests a tailored web-based delivery of the program with therapist telephone support may be optimal.

• PwMS with serious co-morbid depression and very advanced disease may not respond well to this self-management approach.

Keywords:

• Multiple sclerosis
• pain
• cognitive behavior therapy
• acceptance and commitment therapy
• case series
• longitudinal study

Acknowledgements

We would like to thank all the participants in the program, and express our gratitude to the MS Society UK PPI members, Ms Sarah Bittlestone, Dr Val Gouby, Dr Jo Wilson, for providing invaluable feedback on the treatment materials and ratings.

Disclosure statement

The authors report no conflicts of interest.

Funding

This study was funded by a grant awarded to Professor Rona Moss-Morris by the Multiple Sclerosis Society UK [Grant number: 967/12].