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:

Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis.

Importance: Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients. Objective: To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain. Data Sources: For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched. Study Selection: Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain. Data Extraction and Synthesis: Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs. Main Outcomes and Measures: The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function. Results: Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = -0.51; 95% CI, -0.76 to -0.26) and reduced opioid dose (Cohen d = -0.26; 95% CI, -0.44 to -0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = -0.70), hypnosis (Cohen d = -0.54), suggestion (Cohen d = -0.68), and cognitive behavioral therapy (Cohen d = -0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias. Conclusions and Relevance: The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.
Authors
Garland, EL; Brintz, CE; Hanley, AW; Roseen, EJ; Atchley, RM; Gaylord, SA; Faurot, KR; Yaffe, J; Fiander, M; Keefe, FJ
MLA Citation
Garland, Eric L., et al. “Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis..” Jama Intern Med, Nov. 2019. Pubmed, doi:10.1001/jamainternmed.2019.4917.
URI
https://scholars.duke.edu/individual/pub1418101
PMID
31682676
Source
pubmed
Published In
Jama Internal Medicine
Published Date
DOI
10.1001/jamainternmed.2019.4917

Indices of pain variability: a paradigm shift.

Authors
Winger, JG; Plumb Vilardaga, JC; Keefe, FJ
MLA Citation
Winger, Joseph G., et al. “Indices of pain variability: a paradigm shift..” Pain, vol. 160, no. 11, Nov. 2019, pp. 2411–12. Pubmed, doi:10.1097/j.pain.0000000000001627.
URI
https://scholars.duke.edu/individual/pub1388002
PMID
31145216
Source
pubmed
Published In
Pain
Volume
160
Published Date
Start Page
2411
End Page
2412
DOI
10.1097/j.pain.0000000000001627

Coping Skills Training and Acceptance and Commitment Therapy for Symptom Management: Feasibility and Acceptability of a Brief Telephone-Delivered Protocol for Patients With Advanced Cancer.

CONTEXT: Patients with advanced cancer face a life-limiting condition that brings a high symptom burden that often includes pain, fatigue, and psychological distress. Psychosocial interventions have promise for managing symptoms but need additional tailoring for these patients' specific needs. Patients with advanced cancer in the community also face persistent barriers-availability of interventions in community clinics as well as financial and illness-related factors-to accessing psychosocial interventions. OBJECTIVES: The aim of the present study was to assess the feasibility and acceptability of telephone implementation of Engage, a novel brief combined Coping Skills Training and Acceptance and Commitment Therapy protocol, for reducing symptoms and increasing quality of life in community patients with advanced cancer. METHODS: Adult patients with advanced cancer receiving care in the community received Engage, four 60-minute manualized telephone sessions delivered by a trained psychotherapist and completed pretreatment and post-treatment assessments. RESULTS: Engage was feasible, achieving 100% accrual (N = 24) of a heterogeneous sample of patients with advanced cancer, with good retention (88% completed). Acceptability was demonstrated via satisfaction (mean 29 of 32; SD 2), engagement (95% attendance), and use of skills. Secondary analyses pointed to reductions in pain interference, fatigue, psychological distress, and improvements in psychological acceptance and engagement in value-guided activity after treatment. CONCLUSION: Engage, our brief novel combined Coping Skills and Acceptance and Commitment Therapy intervention, demonstrated initial feasibility and acceptability when delivered over the telephone and increased access for community clinic patients with advanced cancer. Future research will assess the comparative efficacy of Engage in larger randomized trials.
Authors
Plumb Vilardaga, JC; Winger, JG; Teo, I; Owen, L; Sutton, LM; Keefe, FJ; Somers, TJ
MLA Citation
Plumb Vilardaga, Jennifer C., et al. “Coping Skills Training and Acceptance and Commitment Therapy for Symptom Management: Feasibility and Acceptability of a Brief Telephone-Delivered Protocol for Patients With Advanced Cancer..” J Pain Symptom Manage, Sept. 2019. Pubmed, doi:10.1016/j.jpainsymman.2019.09.005.
URI
https://scholars.duke.edu/individual/pub1411901
PMID
31539599
Source
pubmed
Published In
J Pain Symptom Manage
Published Date
DOI
10.1016/j.jpainsymman.2019.09.005

Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer.

OBJECTIVE: Women with metastatic breast cancer (MBC) report high levels of disease-related symptoms including pain, fatigue, psychological distress, and sleep disturbance. Mindfulness may be particularly relevant to women with MBC given the high symptom burden and psychological toll of this disease; however, the topic is understudied among this patient population. Therefore, we aimed to test the associations between mindfulness and patient-reported symptoms among a sample of women with MBC. METHODS: Sixty-four women with MBC completed baseline questionnaires of mindfulness (Five Facet Mindfulness Questionnaire-Short Form [FFMQ-SF]) and symptoms of pain severity and interference, fatigue, psychological distress, and sleep disturbance as part of a randomized controlled trial of a Mindful Yoga intervention. Correlational analyses of data collected at baseline tested associations between the five mindfulness facets (observing, describing, acting with awareness, nonjudging, and nonreactivity) and patient-reported measures of symptoms. RESULTS: Overall, higher mindfulness was associated with lower symptom levels including lower pain severity, pain interference, fatigue, anxiety, depression, and sleep disturbance. However, degree of association varied by mindfulness facet. Nonreactivity, nonjudging, and describing showed the most frequent associations and largest effect sizes across symptoms, while observing showed the least frequent associations and lowest effect sizes. CONCLUSIONS: Mindfulness-and in particular nonreactivity, nonjudging, and describing-may be a personal resource for women with MBC in coping with complex symptoms of this life-threatening illness. Findings are discussed relative to their implications for interventions aimed at increasing mindfulness in this vulnerable population.
Authors
Zimmaro, LA; Carson, JW; Olsen, MK; Sanders, LL; Keefe, FJ; Porter, LS
MLA Citation
Zimmaro, Lauren A., et al. “Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer..” Psychooncology, 2019. Pubmed, doi:10.1002/pon.5223.
URI
https://scholars.duke.edu/individual/pub1319155
PMID
31509614
Source
pubmed
Published In
Psychooncology
Published Date
DOI
10.1002/pon.5223

Acceptability and Feasibility of a Mindfulness-Based Intervention for Pain Catastrophizing among Persons with Sickle Cell Disease.

BACKGROUND: Few investigators have developed and tested nonpharmacological interventions for helping persons with sickle cell disease (SCD) manage persistent pain. AIMS: The purpose of this pilot study was to examine the feasibility and acceptability of a mindfulness-based intervention (MBI) in adults with SCD and chronic pain and to gather preliminary data on its efficacy. DESIGN: Data on feasibility and acceptability, including recruitment, retention, and attendance rates, were collected during a single-site, randomized control trial. Participants were randomly assigned to either a 6-session group telephonic MBI or a wait-listed control. Pain catastrophizing was assessed at baseline and at weeks 1, 3, and 6. SETTING: Outpatient, comprehensive, interdisciplinary sickle cell disease center in the Southeast. PARTICIPANTS/SUBJECTS: Adults at least 18 years of age with a self-reported diagnosis of sickle cell disease who self-identified as having chronic, non-cancer pain that persisted on most days for at least 6 months and adversely affected function and/or well-being. METHODS: Seventy-eight adults were recruited; 18 (23%) declined to participate; 60 were randomly assigned to either the MBI (N = 40) or control (N = 20). Of those, 14 (35%) from the MBI and 12 (60%) from the control group withdrew immediately after random allocation, resulting in 34 evaluable cases (MBI: N = 26; control: N = 8). RESULTS: Among the 26 assigned to MBI, the median number of sessions attended per person was 4; 7 (27%) attended all six sessions. Qualitative findings indicated that MBI participants viewed the program as acceptable and liked the telephonic format, community, and content. Reductions in pain catastrophizing outcomes were identified after intervention. CONCLUSIONS: An MBI is feasible and acceptable for persons with SCD experiencing chronic pain. A larger randomized controlled trial to establish MBI efficacy on pain and related outcomes for SCD will provide nonpharmacologic, behavioral pain management options for nurses and other clinicians caring for persons with SCD and chronic pain.
Authors
Simmons, LA; Williams, H; Silva, S; Keefe, F; Tanabe, P
MLA Citation
Simmons, Leigh Ann, et al. “Acceptability and Feasibility of a Mindfulness-Based Intervention for Pain Catastrophizing among Persons with Sickle Cell Disease..” Pain Manag Nurs, vol. 20, no. 3, June 2019, pp. 261–69. Pubmed, doi:10.1016/j.pmn.2018.10.002.
URI
https://scholars.duke.edu/individual/pub1385885
PMID
31085097
Source
pubmed
Published In
Pain Manag Nurs
Volume
20
Published Date
Start Page
261
End Page
269
DOI
10.1016/j.pmn.2018.10.002