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:

Spouse Criticism/Hostility Toward Partners With Chronic Pain: The Role of Spouse Attributions for Patient Control Over Pain Behaviors.

Spouse attributions regarding displays of pain behaviors by their partners with chronic pain may account for subsequent increases in spouse critical/hostile responses toward their partners. People with chronic low back pain (n = 105) and their pain-free spouses (n = 105) completed electronic diary measures 5 times per day for 14 consecutive days. Key items assessed spouse observations of patient pain behavior, attributions regarding these behaviors, and spouse critical/hostile responses toward patients. Results were 1) spouse observations of patient pain behavior at time 1 predicted high levels of spouse critical/hostile responses toward the patient at time 2. 2) "Internal" attributions (eg, the patient was attempting to influence spouse's feelings) at time 1 predicted high levels of spouse critical/hostile responses toward the patient at time 2. 3) Internal attributions mediated links between spouse-observed pain behaviors at time 1 and levels of spouse critical/hostile responses at time 2. Spouse observations of patient pain behavior was also related to an "external" attribution (ie, patient pain behavior was due to pain condition), but this attribution was not a significant mediator. A vital factor linking spouse scrutiny to spouse critical/hostile responses may be the spouse's ascribed reasons for the patient's grimacing, bracing, complaining, and so forth. Perspective: Results indicate that spouse internal and negative attributions for pain behaviors of their partners with chronic pain may influence subsequent spouse critical/hostile reactions to them. Findings suggest that replacing spouse internal and negative attributions with external, compassionate, and accepting explanations may be useful therapeutic targets for couples coping with chronic pain.
Authors
Burns, JW; Gerhart, J; Post, KM; Smith, DA; Porter, LS; Buvanendran, A; Fras, AM; Keefe, FJ
MLA Citation
Burns, John W., et al. “Spouse Criticism/Hostility Toward Partners With Chronic Pain: The Role of Spouse Attributions for Patient Control Over Pain Behaviors..” J Pain, vol. 19, no. 11, Nov. 2018, pp. 1308–17. Pubmed, doi:10.1016/j.jpain.2018.05.007.
URI
https://scholars.duke.edu/individual/pub1322327
PMID
29864506
Source
pubmed
Published In
J Pain
Volume
19
Published Date
Start Page
1308
End Page
1317
DOI
10.1016/j.jpain.2018.05.007

Publishing the best basic and applied pain science: open science and PAIN.

Authors
Keefe, FJ; Ballantyne, J; Blyth, F; Coghill, RC; Dickenson, A; Dionne, CE; Eccleston, C; Finnerup, NB; Kuner, R; Seminowicz, DA; Sluka, K
MLA Citation
Keefe, Francis J., et al. “Publishing the best basic and applied pain science: open science and PAIN..” Pain, vol. 159, no. 3, Mar. 2018, pp. 405–06. Pubmed, doi:10.1097/j.pain.0000000000001166.
URI
https://scholars.duke.edu/individual/pub1381186
PMID
29443726
Source
pubmed
Published In
Pain
Volume
159
Published Date
Start Page
405
End Page
406
DOI
10.1097/j.pain.0000000000001166

Cognitive behavioral therapy for chronic pain is effective, but for whom?

Moderator analyses are reported for posttreatment outcomes in a large, randomized, controlled effectiveness trial for chronic pain for hip and knee osteoarthritis (N = 256). Pain Coping Skills Training, a form of cognitive behavioral therapy, was compared to usual care. Treatment was delivered by nurse practitioners in patients' community doctors' offices. Consistent with meta-analyses of pain cognitive behavioral therapy efficacy, treatment effects in this trial were significant for several primary and secondary outcomes, but tended to be small. This study was designed to examine differential response to treatment for patient subgroups to guide clinical decision-making for treatment. Based on existing literature, demographic (age, sex, race/ethnicity, and education) and clinical variables (disease severity, body mass index, patient treatment expectations, depression, and patient pain coping style) were specified a priori as potential moderators. Trial outcome variables (N = 15) included pain, fatigue, self-efficacy, quality of life, catastrophizing, and use of pain medication. Results yielded 5 significant moderators for outcomes at posttreatment: pain coping style, patient expectation for treatment response, radiographically assessed disease severity, age, and education. Thus, sex, race/ethnicity, body mass index, and depression at baseline were not associated with level of treatment response. In contrast, patients with interpersonal problems associated with pain coping did not benefit much from the treatment. Although most patients projected positive expectations for the treatment prior to randomization, only those with moderate to high expectations benefited. Patients with moderate to high osteoarthritis disease severity showed stronger treatment effects. Finally, the oldest and most educated patients showed strong treatment effects, while younger and less educated did not.
Authors
Broderick, JE; Keefe, FJ; Schneider, S; Junghaenel, DU; Bruckenthal, P; Schwartz, JE; Kaell, AT; Caldwell, DS; McKee, D; Gould, E
MLA Citation
Broderick, Joan E., et al. “Cognitive behavioral therapy for chronic pain is effective, but for whom?.” Pain, vol. 157, no. 9, Sept. 2016, pp. 2115–23. Pubmed, doi:10.1097/j.pain.0000000000000626.
URI
https://scholars.duke.edu/individual/pub1132941
PMID
27227692
Source
pubmed
Published In
Pain
Volume
157
Published Date
Start Page
2115
End Page
2123
DOI
10.1097/j.pain.0000000000000626

The Communal Coping Model of Pain Catastrophizing in Daily Life: A Within-Couples Daily Diary Study.

UNLABELLED: The Communal Coping Model characterizes pain catastrophizing as a coping tactic whereby pain expression elicits assistance and empathic responses from others. Married couples (N = 105 couples; 1 spouse with chronic low back pain) completed electronic daily diary assessments 5 times/day for 14 days. In these diaries, patients reported pain catastrophizing, pain, and function, and perceived spouse support, perceived criticism, and perceived hostility. Non-patient spouses reported on their support, criticism, and hostility directed toward patients, as well as their observations of patient pain and pain behaviors. Hierarchical linear modeling tested concurrent and lagged (3 hours later) relationships. Principal findings included the following: a) within-person increases in pain catastrophizing were positively associated with spouse reports of patient pain behavior in concurrent and lagged analyses; b) within-person increases in pain catastrophizing were positively associated with patient perceptions of spouse support, criticism, and hostility in concurrent analyses; c) within-person increases in pain catastrophizing were negatively associated with spouse reports of criticism and hostility in lagged analyses. Spouses reported patient behaviors that were tied to elevated pain catastrophizing, and spouses changed their behavior during and after elevated pain catastrophizing episodes. Pain catastrophizing may affect the interpersonal environment of patients and spouses in ways consistent with the Communal Coping Model. PERSPECTIVE: Pain catastrophizing may represent a coping response by which individuals' pain expression leads to assistance or empathic responses from others. Results of the present study support this Communal Coping Model, which emphasizes interpersonal processes by which pain catastrophizing, pain, pain behavior, and responses of significant others are intertwined.
Authors
Burns, JW; Gerhart, JI; Post, KM; Smith, DA; Porter, LS; Schuster, E; Buvanendran, A; Fras, AM; Keefe, FJ
MLA Citation
Burns, John W., et al. “The Communal Coping Model of Pain Catastrophizing in Daily Life: A Within-Couples Daily Diary Study..” J Pain, vol. 16, no. 11, Nov. 2015, pp. 1163–75. Pubmed, doi:10.1016/j.jpain.2015.08.005.
URI
https://scholars.duke.edu/individual/pub1087732
PMID
26320945
Source
pubmed
Published In
J Pain
Volume
16
Published Date
Start Page
1163
End Page
1175
DOI
10.1016/j.jpain.2015.08.005

The promise and challenge of virtual gaming technologies for chronic pain: the case of graded exposure for low back pain.

Virtual reality (VR) technologies have been successfully applied to acute pain interventions and recent reviews have suggested their potential utility in chronic pain. The current review highlights the specific relevance of VR interactive gaming technologies for pain-specific intervention, including their current use across a variety of physical conditions. Using the example of graded-exposure treatment for pain-related fear and disability in chronic low back pain, we discuss ways that VR gaming can be harnessed to optimize existing chronic pain therapies and examine the potential limitations of traditional VR interfaces in the context of chronic pain. We conclude by discussing directions for future research on VR-mediated applications in chronic pain.
Authors
Trost, Z; Zielke, M; Guck, A; Nowlin, L; Zakhidov, D; France, CR; Keefe, F
MLA Citation
Trost, Zina, et al. “The promise and challenge of virtual gaming technologies for chronic pain: the case of graded exposure for low back pain..” Pain Manag, vol. 5, no. 3, 2015, pp. 197–206. Pubmed, doi:10.2217/pmt.15.6.
URI
https://scholars.duke.edu/individual/pub1289078
PMID
25971643
Source
pubmed
Published In
Pain Manag
Volume
5
Published Date
Start Page
197
End Page
206
DOI
10.2217/pmt.15.6