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 & Neurosciences
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 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 & Neurosciences
Awarded By
The University of Texas at Dallas
Role
Principal Investigator
Start Date
End Date

Publications:

Effects of a Weight and Pain Management Program in Patients With Rheumatoid Arthritis With Obesity: A Randomized Controlled Pilot Investigation.

BACKGROUND: Obesity is associated with poor outcomes for patients with rheumatoid arthritis (RA). Effective weight management is imperative. Although traditional lifestyle behavioral weight loss programs have demonstrated efficacy for reducing weight, these interventions do not meet the pain-related weight loss challenges of RA patients with obesity. OBJECTIVE: A 12-session group program (90 minutes per session) was developed integrating pain coping skills training into a lifestyle behavioral weight loss intervention. In addition to the weekly group sessions, participants engaged in supervised exercise sessions 3 times per week. METHODS: Through a small, pilot randomized trial, 50 participants were randomized to receive the intervention (n = 29) or standard care of RA (n = 21). Feasibility data (i.e., accrual, attrition, adherence) was examined using descriptive statistics (e.g., percent). We examined patterns of change in study outcomes from baseline to follow-up separately for the intervention and standard care arms using descriptive statistics and paired t tests. Effect sizes are also presented. RESULTS: Of those randomized to the intervention group,79.3% initiated treatment, with participants attending 74.3% of group skills sessions and 64.2% of exercise sessions. Intervention participants evidenced reductions in weight (mean, -2.28 kg) and waist circumference (mean, -4.76 cm) and improvements in physical functioning, eating behaviors, pain, and self-efficacy for weight control. CONCLUSIONS: Findings suggest that incorporating a combined pain coping skills training and behavioral weight loss intervention into medical management of RA may improve outcomes. Study accrual and attrition, as well as intervention adherence, will inform future, larger randomized efficacy trials of the intervention.Retrospectively registered: January 29, 2020, NCT04246827.
Authors
Somers, TJ; Blumenthal, JA; Dorfman, CS; Huffman, KM; Edmond, SN; Miller, SN; Wren, AA; Caldwell, D; Keefe, FJ
MLA Citation
Somers, Tamara J., et al. “Effects of a Weight and Pain Management Program in Patients With Rheumatoid Arthritis With Obesity: A Randomized Controlled Pilot Investigation.J Clin Rheumatol, Oct. 2021. Pubmed, doi:10.1097/RHU.0000000000001793.
URI
https://scholars.duke.edu/individual/pub1499488
PMID
34670994
Source
pubmed
Published In
J Clin Rheumatol
Published Date
DOI
10.1097/RHU.0000000000001793

The influence of a cognitive behavioural approach on changing patient expectations for conservative care in shoulder pain treatment: a protocol for a pragmatic randomized controlled trial.

BACKGROUND: Despite similar outcomes for surgery and conservative care, the number of surgeries to treat rotator cuff related shoulder pain has increased. Interventions designed to enhance treatment expectations for conservative care have been shown to improve patient expectations, but no studies have yet explored whether such interventions influence patient decisions to pursue surgery. The purpose of this randomized clinical trial is to examine the effect of an intervention designed to improve expectations of conservative care on the decision to have surgery. METHODS: We will test the effectiveness of the Patient Engagement, Education, and Restructuring of Cognitions (PEERC) intervention which is intended to change expectations regarding conservative care. The PEERC intervention will be evaluated in a randomized, pragmatic "add-on" trial, to better understand the effect the intervention has on outcomes. Ninety-four (94) participants with rotator cuff related shoulder pain referred for physical therapy will be randomized to receive either impairment-based care or impairment-based care plus PEERC. Both groups will receive impairment-based conservative treatment created by compiling the evidence associated with established, effective interventions. Participants assigned to the impairment-based care plus PEERC condition will also receive the PEERC intervention. This intervention, informed by principles of cognitive behavioral therapy, involves three components: (1) strategies to enhance engagement, (2) education and (3) cognitive restructuring and behavioral activation. Outcomes will be assessed at multiple points between enrolment and six months after discharge. The primary outcome is patient reported decision to have surgery and the secondary outcomes are pain, function, expectations and satisfaction with conservative care. DISCUSSION: Rotator cuff related shoulder pain is highly prevalent, and because conservative and surgical treatments have similar outcomes, an intervention that changes expectations about conservative care could alter patient reports of their decision to have surgery and ultimately could lead to lower healthcare costs and decreased risk of surgical complications. TRIAL REGISTRATION: This study is registered as NCT03353272 at ClincialTrials.gov.
Authors
Myers, H; Keefe, F; George, SZ; Kennedy, J; Lake, AD; Martinez, C; Cook, C
MLA Citation
Myers, Heather, et al. “The influence of a cognitive behavioural approach on changing patient expectations for conservative care in shoulder pain treatment: a protocol for a pragmatic randomized controlled trial.Bmc Musculoskelet Disord, vol. 22, no. 1, Aug. 2021, p. 727. Pubmed, doi:10.1186/s12891-021-04588-9.
URI
https://scholars.duke.edu/individual/pub1494623
PMID
34429074
Source
pubmed
Published In
Bmc Musculoskeletal Disorders
Volume
22
Published Date
Start Page
727
DOI
10.1186/s12891-021-04588-9

Pilot study of an internet-based pain coping skills training program for patients with systemic Lupus Erythematosus.

BACKGROUND: Patients with Systemic Lupus Erythematosus (SLE) often experience pain and other symptoms that negatively impact quality of life. Interventions that enhance the use of behavioral and cognitive coping strategies may lead to improved outcomes among patients with SLE. Pain coping skills training (PCST) programs have been shown to improve outcomes among patients with other rheumatic conditions, but there have been no trials of PCST among patients with SLE. This study was a preliminary assessment of the feasibility and efficacy of painTRAINER, an automated, internet-based PCST program, among patients with SLE. METHODS: Participants (n = 60) with SLE from one health care system were randomly assigned with equal allocation to painTRAINER or a wait list control group. PainTRAINER involves 8 modules; participants were instructed to complete one module weekly, along with practice activities for each cognitive or behavioral coping skill. Outcome measures were assessed at baseline and 9-week follow-up, including the Pain Catastrophizing Scale, PROMIS Subscales (Pain Interference, Physical Function, Sleep Disturbance, Anxiety, Depression, Fatigue and Participation), and the LupusPRO questionnaire. Mean changes in outcomes from baseline to follow up and Cohen's d effect sizes were computed. RESULTS: Effect sizes for the painTRAINER group (relative to the wait list group) were small, with changes being greatest for the PROMIS Depression score (d = - 0.32). Among those randomized to the painTRAINER group, 50% accessed the program ("painTRAINER users"). Most of those who did not access the program stated that they did not receive instructions via email. Effect sizes for "painTRAINER users" (relative to wait list) were larger than for the whole painTRAINER group: Pain Catastrophizing d = - 0.60, PROMIS Pain Interference d = - 0.3., PROMIS Depression d = - 0.44, LupusPRO Health-Related Quality of Life d = 0.30. CONCLUSIONS: PainTRAINER users reported meaningful improvements in multiple physical and psychological outcomes, supporting the potential of PCST programs to benefit individuals with SLE. However, strategies are needed to improve engagement with the program and tailor content to comprehensively address key SLE symptoms and challenges. TRIAL REGISTRATION: NCT03933839 , May 1, 2019.
Authors
Allen, KD; Beauchamp, T; Rini, C; Keefe, FJ; Bennell, KL; Cleveland, RJ; Grimm, K; Huffman, K; Hu, DG; Santana, A; Saxena Beem, S; Walker, J; Sheikh, SZ
MLA Citation
Allen, Kelli D., et al. “Pilot study of an internet-based pain coping skills training program for patients with systemic Lupus Erythematosus.Bmc Rheumatol, vol. 5, no. 1, June 2021, p. 20. Pubmed, doi:10.1186/s41927-021-00191-6.
URI
https://scholars.duke.edu/individual/pub1485859
PMID
34134788
Source
pubmed
Published In
Bmc Rheumatol
Volume
5
Published Date
Start Page
20
DOI
10.1186/s41927-021-00191-6

Racial Differences in Pain and Function Following Knee Arthroplasty: A Secondary Analysis From a Multicenter Randomized Clinical Trial.

OBJECTIVE: The assessment of racial differences in pain and function outcome following knee arthroplasty (KA) has received little attention despite very substantial literature exploring a variety of other prognostic factors. The present study was undertaken to determine whether race was associated with KA outcome after accounting for potential confounding factors. METHODS: We conducted a secondary analysis of a randomized clinical trial of 384 participants with moderate-to-high pain catastrophizing who underwent KA. Preoperative measures included race/ethnicity status as well as a variety of potential confounders, including socioeconomic status, comorbidity, and bodily pain. Outcome measures were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scales as well as performance measures. Linear mixed-effects models compared outcomes over a 1-year follow-up period for African American versus non-African American participants. RESULTS: WOMAC pain scores differences for African American versus non-African American participants averaged ~2 points in unadjusted analyses and 1-1.5 points in adjusted analyses. In adjusted analyses, follow-up WOMAC function scores differed by 6 points for African Americans compared to non-African Americans (P = 0.002). CONCLUSION: African Americans generally had worse pain, function, and performance prior to KA and worse scores after surgery, but differences were small and attenuated by ~25-50% after adjustment for potential confounding. Only WOMAC function scores showed clinically important postsurgical differences in adjusted analyses. Clinicians should be aware that after adjustment for potential confounders, African Americans have approximately equivalent outcomes compared to others, with the exception of WOMAC function score.
Authors
Riddle, DL; Slover, J; Keefe, FJ; Ang, DC; Dumenci, L; Perera, RA
MLA Citation
Riddle, Daniel L., et al. “Racial Differences in Pain and Function Following Knee Arthroplasty: A Secondary Analysis From a Multicenter Randomized Clinical Trial.Arthritis Care Res (Hoboken), vol. 73, no. 6, June 2021, pp. 810–17. Pubmed, doi:10.1002/acr.24177.
URI
https://scholars.duke.edu/individual/pub1434072
PMID
32144884
Source
pubmed
Published In
Arthritis Care Res (Hoboken)
Volume
73
Published Date
Start Page
810
End Page
817
DOI
10.1002/acr.24177

Physical rehabilitation research and pain science.

Authors
Sterling, M; Keefe, FJ
MLA Citation
Sterling, Michele, and Francis J. Keefe. “Physical rehabilitation research and pain science.Pain, vol. 162, no. 11, Nov. 2021, pp. 2621–24. Epmc, doi:10.1097/j.pain.0000000000002326.
URI
https://scholars.duke.edu/individual/pub1499831
PMID
34652317
Source
epmc
Published In
Pain
Volume
162
Published Date
Start Page
2621
End Page
2624
DOI
10.1097/j.pain.0000000000002326