Developing a Tailored Psychosocial Education Intervention for Chronic Pain Management for Asian Americans

Developing a Tailored Psychosocial Education Intervention for Chronic Pain Management for Asian Americans in the Community

Chronic pain is a major population health issue affecting more than 100 million Americans and variations in chronic pain experiences have been widely documented, including differences in pain burden and likelihood of undertreatment. Evidence regarding chronic pain experiences of Asian Americans is limited, as are resources and evidence-based programs for this group. Our exploratory, developmental study will provide evidence of feasibility and acceptability of a tailored psychosocial education intervention to reduce pain catastrophizing and improve pain outcomes for Asian Americans.

Variances in chronic pain experience exists in the US, including between-person differences in pain burden and likelihood of undertreatment. Asian Americans (AA) are most likely to be limited in English proficiency, which may contribute to their linguistic and social isolation. Underdiagnosis and underreporting of pain among AA have been reported. AA may discourage reporting their pain to avoid burdening others or being seen as weak. Rather than seeking medical assistance, AA have been reported to tend to accept the pain as natural or to suffer to maintain their independence. Our preliminary studies found that Korean Americans (KA) exhibited higher levels of pain severity and pain catastrophizing compared to their counterparts living in Korea. However, very few evidence-based programs are available that can be implemented for this linguistically/socially isolated group. This proposed study aims to fill critical knowledge gaps in pain research by providing evidence of feasibility and acceptability of a tailored psychosocial pain education intervention for AA using the KA as an exemplar. Using a sequential exploratory mixed-method design incorporating a Community-Based Participatory Research approach, we will: (1) iteratively adapt and integrate a previously established psychosocial education intervention for KA to develop an effective program to improve pain outcomes for understudied KA with chronic pain in the community; conduct KA Community Advisory Board meetings and participant focus group interviews to improve the intervention design and content, and (2) evaluate the feasibility and acceptability of the adapted psychosocial education intervention using a single group, pre-posttest design with 30 foreign-born KA with chronic pain. We will conduct a survey to assess improvements in the outcomes (i.e., pain catastrophizing, pain intensity/interference) at 3 time points (pre-test, post-test, 12 weeks after the intervention). Post-intervention in-depth interviews will be conducted with subset of the participants (n = 10) on their reflections about the program. Feasibility and acceptability will be evaluated by integrating quantitative (i.e., recruitment/retention rate, participants engagement) and qualitative (i.e., perceived appropriateness) findings. Achievement of study goals will demonstrate for the first time that a nurse-led, community-based psychosocial education intervention to reduce chronic pain may be feasible and acceptable, forming the basis for a larger efficacy trial to test the tailored intervention.

Inclusion Criteria:

1. Female and male
2. ≥ 18 years old
3. Self-reported foreign born Korean Americans
4. Self-reported pain most days of the month for at least 3 months
5. Pain must be non-malignant, but may have more than one pain source

Exclusion Criteria:

1. Having malignant pain (e.g., cancer or HIV-related)

2. Demonstrating significant cognitive impairment (based on results of a cognitive screener-Short Portable Mental Status Questionnaire)

3. Having current, uncontrolled serious psychological disturbance (e.g., schizophrenia, bipolar disorder) or active substance abuse based on self-report

4. Having low literacy skills in Korean or English (unable to understand the written consent and to sign)

5. Undergoing other psychosocial treatment for pain

   • If excluding a population or group that may benefit from the research, please provide justification: We will exclude children. The original intervention (LAMP) trial has established for efficacy in reducing chronic pain outcomes in adult population. Children are not our target population as we focus on developing a culturally tailored chronic pain management program based on LAMP.