The ability to be connected and act according to bodily information is fundamental in chronic pain adjustment. This study aims to test the feasibility of an intervention designed to improve interoceptive sensibility, i.e., the ability to sense, interpret, and regulate bodily sensations in chronic musculoskeletal pain patients.
Background: Interoceptive sensibility (IS), the self-reported experience of internal states, involves individuals' capacity to sense, interpret, integrate, and regulate their own bodily information. Disruptions in interoceptive processes are often associated with various health conditions, including mental illness and chronic pain (CP). Individuals with chronic musculoskeletal pain present disruptions in IS associated with worse pain adjustment. While there is a growing body of research testing interoceptive-based interventions on both healthy and clinical samples, interventions specifically tailored for individuals with CP are limited. Furthermore, despite evidence that interventions such as mindfulness or meditation improve IS in incividuals with CP, the mechanisms contributing to enhanced pain-related outcomes remain unknown. Additionally, in Portugal, there is a lack of cost-effective interventions for CP in both public health services and the community. This study aims to address these gaps by evaluating the feasibility of a program designed for a community setting. The program is specifically developed to enhance IS, potentially improving pain adjustment in individuals with chronic musculoskeletal pain - one of the most prevalent and burdensome types of pain globally. The study compares a group receiving an interoception-based intervention, intending to improve IS, against a control group on a waiting list, examining the intervention's acceptability, feasibility, appropriateness, and estimated treatment effects. Method: The recruitment process will be conducted through the study website, providing information about the research team, study objectives, and general details about the intervention structure and session schedules. Potential participants must register on the website to enroll in the study. Measurements will be collected anonymously and online (via Qualtrics) using self-report questionnaires at four points in time: before (T0), in the middle (T1), at the end (T2), and one month after the intervention (T3). Additionally, participants in the intervention group will complete an anonymous evaluation checklist after each session and a final evaluation checklist assessing the study's acceptability, appropriateness, and feasibility. Block-stratified randomization of participants for each group (intervention/control), based on sex and geographical area (Lisbon/Évora), will be conducted using randomization software. The intervention includes four stages addressing different IS skills with 8 weekly sessions (4-6 participants), each lasting 1.5 hours. These sessions will be delivered by two trained psychomotor therapists with clinical experience, supplemented by daily home exercises. To ensure fidelity of the procedures during sessions, recordings will be made for later review (therapists cross-confirm each other's sessions). Discussion: It is expected that, with or without protocol modifications: 1) The protocol components are suitable to conduct a larger study; 2) the program has good acceptability, appropriateness, feasibility, and participant adherence.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
71
Intervention will include body awareness, sensorial, and relaxation exercises, plus homework.
Iscte - University Institute of Lisbon
Lisbon, Lisbon District, Portugal
University of Évora
Evora, Évora District, Portugal
Feasibility - Sessions' acceptability
Session evaluation checklist - 7 questions answered on a 5-point scale ranging from 1 (totally disagree) to 5 (completely agree), plus 1 open question asking for improvement suggestions.
Time frame: Up to 24 hours after each intervention session.
Feasibility - Program acceptability, appropriateness, and feasibility
Program evaluation checklist: 21 questions answered on a 5-point scale ranging from 1 (totally disagree) to 5 (completely agree) plus 3 open questions.
Time frame: Up to 72 hours after the end of the intervention (T2)
Feasibility - Recruitment, retention, and attendance rates
Number of participants recruited, number of participants included in the study (among those who are eligible), and average number of sessions attended in intervention by participants.
Time frame: Up to 12 weeks after the end of the intervention
Feasibility - safety/unexpected events
Number and type of unexpected events reported by the participants during their participation in the intervention.
Time frame: Up to 12 weeks after the end of the intervention
Feasibility - Treatment Fidelity Check
Sessions will be audio-recorded and an independent therapist will confirm if planned procedures were done.
Time frame: Up to 12 weeks after the end of the intervention.
Interoceptive sensibility
Multidimensional Assessment of Interoceptive Awareness assesses IS skills, such as identifying bodily sensations, body-mind relationships, and body trust, through 32 items rated on a 6-point Likert scale. Higher scores expresses higher IS levels.
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Time frame: Within the 72-hour period before the first session (T0); up to 72 hours after the fourth session (T1), up to 72 hours after the last (eighth) session (T2), and one month after the last session (T3).
Psychological flexibility
The Portuguese Comprehensive Assessment of Acceptance and Commitment Therapy Processes is an 18-item scale that measures psychological flexibility (openness to experience, behavioral awareness, valued action) on a 7-point rating scale. Higher scores indicate greater psychological flexibility.
Time frame: Within the 72-hour period before the first session (T0); up to 72 hours after the fourth session (T1), up to 72 hours after the last (eighth) session (T2), and one month after the last session (T3).
Emotion regulation
Difficulties in Emotion Regulation Scale - Short Form assesses difficulties in emotion regulation (e.g., nonacceptance of emotional responses, difficulty engaging in goal-directed behavior or in impulse control, lack of emotional awareness), through 18 items. Higher scores correspond to more difficulty in emotion regulation.
Time frame: Within the 72-hour period before the first session (T0); up to 72 hours after the fourth session (T1), up to 72 hours after the last (eighth) session (T2), and one month after the last session (T3).
Pain-related self-efficacy
The Pain Self-Efficacy Questionnaire assesses the individuals' confidence level in reaching activities or goals, despite pain with 10 items rated on a 7-point scale. Higher scores represent higher self-efficacy levels.
Time frame: Within the 72-hour period before the first session (T0); up to 72 hours after the fourth session (T1), up to 72 hours after the last (eighth) session (T2), and one month after the last session (T3).
Pain catastrophizing
Pain Catastrophizing Scale measures pain-related catastrophic thinking through 13 items rated on a 5-point scale.Higher levels express higher levels of pain catastrophizing.
Time frame: Within the 72-hour period before the first session (T0); up to 72 hours after the fourth session (T1), up to 72 hours after the last (eighth) session (T2), and one month after the last session (T3).
Activity patterns
Activity Patterns Scale measures activity patterns through 24 questions responded to on a 5-point scale (avoidance, persistence, and pacing related patterns). Higher levels represent more use of the respective pattern.
Time frame: Within the 72-hour period before the first session (T0); up to 72 hours after the fourth session (T1), up to 72 hours after the last (eighth) session (T2), and one month after the last session (T3).
Affective distress (depression and anxiety)
Depression Anxiety Stress Scales evaluate depression/anxiety/stress levels experienced during the previous week, through 21 items rated on a 4-point scale. Higher levels represent higher depression and anxiety levels.
Time frame: Within the 72-hour period before the first session (T0); up to 72 hours after the fourth session (T1), up to 72 hours after the last (eighth) session (T2), and one month after the last session (T3).
Pain severity
Brief Pain Inventory assesses pain-related disability (e.g., general activities, walking, work, mood) through 7 items rated on 11-point numerical scales; Graded Chronic Pain Scale-Revised (Von Korff et al., 2020) identify chronic pain individuals, grading their pain severity, through 6 items.
Time frame: Within the 72-hour period before the first session (T0); up to 72 hours after the fourth session (T1), up to 72 hours after the last (eighth) session (T2), and one month after the last session (T3).
Physical function and Vitality
Medical Outcomes Study-36 - Short Form 36v2 assesses functional limitations in daily physical activities, and vitality, through 10 and 4 items, rated on 4 and 5-point scales, respectively. Higher scores correspond to higher physical function and vitality.
Time frame: Within the 72-hour period before the first session (T0); up to 72 hours after the fourth session (T1), up to 72 hours after the last (eighth) session (T2), and one month after the last session (T3).