A protocol for a wait list control trial of an intervention to improve pain and depressive symptoms among middle-aged and older African American women

Background: Pain and depression frequently co-occur among older adults with comorbidities and can exacerbate one another. The intersection of race, gender and age puts older African American women at high risk of experiencing comorbid pain and depression. The purpose of this study is to test the feasibility and acceptability of a 12-week behavioral activation intervention called DAPPER (Depression and Pain Perseverance through Empowerment and Recovery) that uses non-pharmacological, tailored strategies to target pain and mood symptoms. We will measure pain intensity and depressive symptoms as outcomes, although we are not powered to test differences. Methods: We describe the protocol for this study that uses a randomized waitlist control design to examine acceptability and feasibility of an intervention. The study population is comprised of self-identified African American women, 50 years of age or older with chronic pain and who self-report of depressive symptoms. Participants must also be pre-frail or frail and have an ADL or IADL limitation. The intervention consists of eight 1-2-h visits with a nurse interventionist via in-person or virtual telecommunication methods and two visits for non-invasive specimen collection. The primary outcomes include goal attainment, pain and depressive symp-toms. Secondary outcomes include stress, frailty, and communication with providers. Follow-up qualitative in-terviews are conducted with participants to assess intervention acceptability. Discussion: Findings from this pilot study will provide further evidence supporting the use of non -pharmacological techniques to intervene in the cycle of pain and depression among an at-risk sub-population.