Monday, August 8, 2022

Artificial Intelligence May Help More Patients Access Cognitive-Behavioral Therapy for Chronic Pain

Patients with chronic pain who receive cognitive-behavioral therapy that uses artificial intelligence to adjust treatment (AI-CBT-CP) experience similar outcomes as those who receive cognitive-behavioral therapy for chronic pain (CBT-CP) delivered by a therapist over the telephone, suggests a study published today in JAMA Internal Medicine.

Although CBT-CP—which targets maladaptive thought processes—is known to be a safe alternative to pharmacotherapy for the treatment of pain, “many patients do not have easy access to CBT-CP or receive a lower dose than intended,” wrote John D. Piette, M.Sc., Ph.D., of the University of Michigan School of Public Health and colleagues. This “trial indicated that despite using less therapist time, AI-CBT-CP achieved outcomes that were noninferior to outcomes of patients offered an equal number of 45-minute telephone sessions with a CBT-CP therapist.”

Piette and colleagues used medical records from two health care systems in the Department of Veterans Affairs (VA) from June 2017 to September 2019 to identify patients with chronic back pain who met the following criteria: at least two documented reports of moderate or worse pain intensity (defined as a 4 or above on the Numerical Rating Scale) during the prior year; moderate or worse pain-related disability (defined as a score of 5 or above on the Roland Morris Disability Questionnaire, or RMDQ); and moderate or worse musculoskeletal pain during three or more of the prior six months. A total of 278 participants were randomized to either the AI-CBT-CP group or the therapist-delivered telephone CBT-CP group.

Participants in both groups received 10 weekly sessions of CBT-CP that addressed pain coping skills, patient-selected behavioral goals, and step counts. Participants receiving therapist-delivered CBT-CP were offered 45-minute telephone sessions weekly; these sessions included a review of the patient’s pedometer logs and skill practice, a presentation of new skill information, the selection of behavioral goals, and the use of problem-solving techniques to address goal completion barriers. Participants receiving AI-CBT-CP completed daily interactive voice response (IVR) calls during which they described their step counts, sleep, pain intensity, interference, mood, self-efficacy, CBT skill practice, and progress toward behavioral goals. This daily report was used by an AI engine to make weekly recommendations for either a 45-minute or 15-minute therapist-delivered telephone session or an individualized IVR-delivered therapist message for 10 weeks. All participants were evaluated using the RMDQ at three and six months.

The researchers found that the participants’ three-month mean RMDQ score difference between AI-CBT-CP and standard CBT-CP was −0.72 points and the six-month difference was −1.24—findings that the authors noted suggest that participants receiving 10 weeks of AI-CBT-CP had noninferior outcomes for pain-related function compared with participants receiving 10 weeks of 45-minute telephone sessions with a CBT-CP therapist. “AI-CBT-CP achieved these outcomes with only 30% of the clinician time required for the comparison program of weekly 45-minute therapist sessions,” Piette and colleagues wrote.

They concluded, “Given that AI-CBT-CP required less clinician-patient contact time, patients may find the intervention more convenient, and health systems could use it to treat more patients without additional clinical resources.”

For related information, see the Psychiatric News article “Integrated Behavioral Approaches Show Promise in Treating Pain.”

(Image: iStock/Charday Penn)


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