Francis Keefe

Overview:

The primary aim of our research over the past year has been to evaluate the efficacy of cognitive-behavioral treatments for arthritis pain. We are conducting two treatment outcome studies supported by grants from the National Institute of Arthritis, Musculoskeletal, and Skin Diseases. The first project, conducted with osteoarthritis patients, seeks to determine whether aerobic exercise training can enhance the effects of a cognitive behavior therapy (CBT) intervention for managing pain and disability. The CBT intervention is innovative in that it systematically involves spouses in training in pain coping skills. The second project, tests the long-term effectiveness of a relapse prevention training intervention. This study will feature the use of newly developed daily study methods to analyze the long-term effects of pain coping skills training on daily pain.

In addition, in conjunction with Lara Schanberg of the Department of Medicine we are carrying out a study funded by the Arthritis Foundation that examines the effects of a pain coping skills training regimen for pediatric fibromyalgia patients.

Finally, we are currently gathering pilot data for two new research projects. One project seeks to evaluate the efficacy of a cognitive behavior theapy and education intervention for managing pain in patients having breast cancer and prostate cancer. The second project examines the efficacy of patient controlled compression protocol in the management of pain during mammography.

Positions:

Professor in Psychiatry and Behavioral Sciences

Psychiatry & Behavioral Sciences, Behavioral Medicine
School of Medicine

Professor in Psychology andNeuroscience

Psychology and Neuroscience
Trinity College of Arts & Sciences

Professor in Anesthesiology

Anesthesiology
School of Medicine

Professor in Medicine

Medicine, Rheumatology and Immunology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 1971

Bowdoin College

M.S. 1973

Ohio State University

Ph.D. 1975

Ohio State University

Grants:

Training in Psychological Intervention Research

Administered By
Psychology and Neuroscience
Awarded By
National Institutes of Health
Role
Training Faculty
Start Date
End Date

Improving Lung Transplant Outcomes with Coping Skills and Physical Activity

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Reducing the Transition from Acute to Chronic Musculoskeletal Pain among Older Adults

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
Awarded By
University of North Carolina - Chapel Hill
Role
Principal Investigator
Start Date
End Date

Improving Veteran Access To Integrated Management of Chronic Back Pain

Administered By
Duke Clinical Research Institute
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Development of a Virtual Reality Graded Exposure Intervention for Chronic Low Back Pain

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
Role
Principal Investigator
Start Date
End Date

Publications:

Ninety-day and one-year healthcare utilization and costs after knee arthroplasty.

OBJECTIVES: This study examined ninety-day and one-year postoperative healthcare utilization and costs following total knee arthroplasty (TKA) from the health sector and patient perspectives. DESIGN: This study relied on: 1) patient-reported medical resource utilization data from diaries in the Knee Arthroplasty Pain Coping Skills Training (KASTPain) trial; and 2) Medicare fee schedules. Medicare payments, patient cost-sharing, and patient time costs were estimated. Generalized linear mixed models were used to identify baseline predictors of costs. RESULTS: In the first ninety days following TKA, patients had an average of 29.7 outpatient visits and 6% were hospitalized. Mean total costs during this period summed to $3,720, the majority attributed to outpatient visit costs (84%). Over the year following TKA, patients had an average of 48.9 outpatient visits, including 33.2 for physical therapy. About a quarter (24%) of patients were hospitalized. Medical costs were incurred at a decreasing rate, from $2,428 in the first six weeks to $648 in the last six weeks. Mean total medical costs across all patients over the year were $8,930, including $5,328 in outpatient costs. Total costs were positively associated with baseline Charlson comorbidity score (P < 0.01). Outpatient costs were positively associated with baseline Charlson comorbidity score (P = 0.03) and a bodily pain burden summary score (P < 0.01). Mean patient cost-sharing summed to $1,342 and time costs summed to $1,346. CONCLUSIONS: Costs in the ninety days and year after TKA can be substantial for both healthcare payers and patients. These costs should be considered as payers continue to explore alternative payment models.
Authors
Hung, A; Li, Y; Keefe, FJ; Ang, DC; Slover, J; Perera, RA; Dumenci, L; Reed, SD; Riddle, DL
MLA Citation
Hung, A., et al. “Ninety-day and one-year healthcare utilization and costs after knee arthroplasty..” Osteoarthritis Cartilage, June 2019. Pubmed, doi:10.1016/j.joca.2019.05.019.
URI
https://scholars.duke.edu/individual/pub1388001
PMID
31176805
Source
pubmed
Published In
Osteoarthritis Cartilage
Published Date
DOI
10.1016/j.joca.2019.05.019

Self-Efficacy for Pain Communication Moderates the Relation Between Ambivalence Over Emotional Expression and Pain Catastrophizing Among Patients With Osteoarthritis.

Pain catastrophizing (ie, the tendency to focus on and magnify pain sensations and feel helpless in the face of pain) is one of the most important and consistent psychological predictors of the pain experience. The present study examined, in 60 patients with osteoarthritis pain who were married or partnered: 1) the degree to which ambivalence over emotional expression and negative network orientation were associated with pain catastrophizing, and 2) whether self-efficacy for pain communication moderated these relations. Hierarchical multiple linear regression analyses revealed a significant main effect for the association between ambivalence over emotional expression and pain catastrophizing; as ambivalence over emotional expression increased, the degree of pain catastrophizing increased. In addition, the interaction between ambivalence over emotional expression and self-efficacy for pain communication was significant, such that as self-efficacy for pain communication increased, the association between ambivalence over emotional expression and pain catastrophizing became weaker. Negative network orientation was not significantly associated with pain catastrophizing. Findings suggest that higher levels of self-efficacy for pain communication may help weaken the effects of ambivalence over emotional expression on pain catastrophizing. In light of these results, patients may benefit from interventions that target pain communication processes and emotion regulation. PERSPECTIVE: This article examines interpersonal processes involved in pain catastrophizing. This study has the potential to lead to better understanding of maladaptive pain coping strategies and possibly better prevention and treatment strategies.
Authors
Van Denburg, AN; Shelby, RA; Caldwell, DS; O'Sullivan, ML; Keefe, FJ
MLA Citation
Van Denburg, Alyssa N., et al. “Self-Efficacy for Pain Communication Moderates the Relation Between Ambivalence Over Emotional Expression and Pain Catastrophizing Among Patients With Osteoarthritis..” J Pain, vol. 19, no. 9, Sept. 2018, pp. 1006–14. Pubmed, doi:10.1016/j.jpain.2018.04.001.
URI
https://scholars.duke.edu/individual/pub1311211
PMID
29631037
Source
pubmed
Published In
J Pain
Volume
19
Published Date
Start Page
1006
End Page
1014
DOI
10.1016/j.jpain.2018.04.001

Spouse criticism and hostility during marital interaction: effects on pain intensity and behaviors among individuals with chronic low back pain.

Individuals with chronic pain may experience negative responses from spouse, family, and friends. Responses such as overt criticism and hostility may be associated with worsening pain and function for chronic pain sufferers. We used a laboratory procedure to evaluate whether variability in spouse criticism/hostility exhibited toward chronic low back pain (CLBP) patients during a conflictual discussion predicted variability in patient pain and function during a subsequent pain-induction task. Chronic low back pain patients (n = 71) and their spouses (n = 71) participated in a 10-minute discussion followed by the patient undergoing a 10-minute structured pain behavior task (SPBT). Spouse criticism/hostility perceived by patients and patient Beck Depression Inventory-II (BDI) scores correlated significantly and positively with pain intensity during the SPBT, whereas perceived spouse hostility, patient BDI scores, and spouse trait hostility correlated significantly and positively with observed pain behaviors during the SPBT. Spouse criticism/hostility coded by raters from video recordings interacted significantly with patient BDI scores, such that observed spouse criticism/hostility was related significantly and positively with pain behaviors only for patients with high BDI scores. Patient sex interacted significantly with observed spouse criticism/hostility, such that observed spouse criticism/hostility was related significantly and positively with pain behaviors only for female patients. Results support the hypothesis that spouse criticism and hostility-actually expressed or perceived-may worsen CLBP patient symptoms. Further, women patients and patients high in depressive symptoms appeared most vulnerable to spouse criticism/hostility. Thus, negative marital communication patterns may be appropriate targets for intervention, especially among these 2 at risk groups.
Authors
Burns, JW; Post, KM; Smith, DA; Porter, LS; Buvanendran, A; Fras, AM; Keefe, FJ
MLA Citation
Burns, John W., et al. “Spouse criticism and hostility during marital interaction: effects on pain intensity and behaviors among individuals with chronic low back pain..” Pain, vol. 159, no. 1, Jan. 2018, pp. 25–32. Pubmed, doi:10.1097/j.pain.0000000000001037.
URI
https://scholars.duke.edu/individual/pub1269528
PMID
28796117
Source
pubmed
Published In
Pain
Volume
159
Published Date
Start Page
25
End Page
32
DOI
10.1097/j.pain.0000000000001037

Pain coping skills training for African Americans with osteoarthritis (STAART): study protocol of a randomized controlled trial.

BACKGROUND: African Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates, more severe pain, and more functional limitations. One key barrier to addressing these disparities has been limited engagement of African Americans in the development and evaluation of behavioral interventions for management of OA. Pain Coping Skills Training (CST) is a cognitive-behavioral intervention with shown efficacy to improve OA-related pain and other outcomes. Emerging data indicate pain CST may be a promising intervention for reducing racial disparities in OA symptom severity. However, there are important gaps in this research, including incorporation of stakeholder perspectives (e.g. cultural appropriateness, strategies for implementation into clinical practice) and testing pain CST specifically among African Americans with OA. This study will evaluate the effectiveness of a culturally enhanced pain CST program among African Americans with OA. METHODS/DESIGN: This is a randomized controlled trial among 248 participants with symptomatic hip or knee OA, with equal allocation to a pain CST group and a wait list (WL) control group. The pain CST program incorporated feedback from patients and other stakeholders and involves 11 weekly telephone-based sessions. Outcomes are assessed at baseline, 12 weeks (primary time point), and 36 weeks (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include self-efficacy, pain coping, pain interference, quality of life, depressive symptoms, and global assessment of change. Linear mixed models will be used to compare the pain CST group to the WL control group and explore whether participant characteristics are associated with differential improvement in the pain CST program. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, Durham Veterans Affairs Medical Center, East Carolina University, and Duke University Health System. DISCUSSION: This culturally enhanced pain CST program could have a substantial impact on outcomes for African Americans with OA and may be a key strategy in the reduction of racial health disparities. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02560922 , registered 9/22/2015.
Authors
Schrubbe, LA; Ravyts, SG; Benas, BC; Campbell, LC; Cené, CW; Coffman, CJ; Gunn, AH; Keefe, FJ; Nagle, CT; Oddone, EZ; Somers, TJ; Stanwyck, CL; Taylor, SS; Allen, KD
MLA Citation
Schrubbe, Leah A., et al. “Pain coping skills training for African Americans with osteoarthritis (STAART): study protocol of a randomized controlled trial..” Bmc Musculoskelet Disord, vol. 17, no. 1, Aug. 2016. Pubmed, doi:10.1186/s12891-016-1217-2.
URI
https://scholars.duke.edu/individual/pub1143730
PMID
27553385
Source
pubmed
Published In
Bmc Musculoskeletal Disorders
Volume
17
Published Date
Start Page
359
DOI
10.1186/s12891-016-1217-2

Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol.

BACKGROUND: Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction. OBJECTIVE: The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist-instructed home exercise leads to greater reductions in pain and improvements in function. DESIGN: An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted. SETTING: The study will be conducted in a community setting. PARTICIPANTS: The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA. INTERVENTION: Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention. MEASUREMENTS: Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks. LIMITATIONS: A self-reported diagnosis of persistent hip pain will be used. CONCLUSIONS: The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist-instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice toward innovative modes of psychosocial health care provision.
Authors
Bennell, KL; Rini, C; Keefe, F; French, S; Nelligan, R; Kasza, J; Forbes, A; Dobson, F; Abbott, JH; Dalwood, A; Vicenzino, B; Harris, A; Hinman, RS
URI
https://scholars.duke.edu/individual/pub1073985
PMID
26023213
Source
pubmed
Published In
Phys Ther
Volume
95
Published Date
Start Page
1408
End Page
1422
DOI
10.2522/ptj.20150119