Addressing chronic pain and suicide risk using Mindfulness-Based Cognitive Therapy: Rationale, design and baseline characteristics

Introduction: Suicide risk and chronic pain are significant public health problems affecting veterans at a disproportionally high rate. There is a dearth of interventions directly targeting both chronic pain and suicide risk. Mindfulness-Based Cognitive Therapy for Pain and Suicide (MBCT-P/S) integrates components from MBCT-Pain and MBCT-Suicide, both of which demonstrate promising effects on their respective targets. We provide an overview of the rationale, design, and baseline characteristics of a randomized clinical trial of MBCT-P/S to assess feasibility and treatment acceptability. Methods: We refined a version of the MBCT-P/S drafted by the researchers through an evidence-based consensus method, integrating feedback from relevant subject matter experts. Veterans (n = 76) reporting death or suicidal ideation and functional impairment from chronic pain were recruited using Veterans Health Administration electronic medical record data. After consent, participants completed a baseline assessment and randomized to MBCT-P/S or Health Education. Results: Baseline data revealed a diverse sample of veterans with a clinically severe profile that differed by condition on key suicide risk variables. Recruitment was completed faster than anticipated, supporting recruitment feasibility. Upcoming milestones include the completion of interventions and 1-, 3-, and 6-month follow-up assessments evaluating pain, suicide risk, and other key clinical indicators. Feasibility assessment will also include study retention by condition and therapist fidelity to the MBCT-P/S. Treatment acceptability will be assessed at the 1-month follow-up. Conclusions: Data generated from this study will provide critical insights into conducting a fully-powered efficacy trial evaluating the impact of MBCT-P/S on pain and suicide risk outcomes.