Cognitive behavioral therapy for chronic pain (CBT-CP) delivered either by a remote health coach or via a self-guided online program can reduce pain severity among patients, according to a study published today in JAMA.
Cognitive behavioral therapy is a widely accepted and effective nonpharmacologic treatment for chronic pain, but is limited by a paucity of trained clinicians, especially in non-urban areas, wrote Lynn DeBar, Ph.D., M.P.H., of the Kaiser Permanente Center for Health Research, and colleagues. “Remote treatment is promising for lowering costs; overcoming patient, clinician, and system barriers; and having greater safety compared with pharmacologic pain treatments.”
DeBar and colleagues recruited 2,331 participants (mean age of 59, 74% women, 75% White, 44% rural) with high-impact musculoskeletal pain. Participants were randomly assigned to one of three groups: The first group received eight one-on-one sessions of CBT-CP with a health coach delivered over phone or video conference; the second group self-completed an eight-session, online CBT-CP program; and the third group received usual care, plus a mailed copy of a pain-management resource guide.
Before and after the intervention, participants completed the 11-item version of the Brief Pain Inventory–Short Form to determine their pain severity. A 30% or greater reduction in someone’s pain inventory score post-intervention was considered a clinically meaningful improvement.
After completing the intervention, 32% of participants in the health coach group and 26.6% of participants in the online intervention group reported meaningful pain improvements, compared with 20.8% in the usual care group. While participants in the health coach group were statistically more likely than those in the self-guided group to show meaningful improvement in their pain severity, the benefit of CBT-CP over usual care was sustained over 12 months in both groups.
The findings “suggest that centralizing delivery of the CBT-CP based programs via telephone/videoconferencing and online interventions is effective, with potential for widespread dissemination into clinical care and health care organizations nationwide,” the authors concluded.
For related information, see the Psychiatric News article "Integrated Behavioral Approaches Show Promise in Treating Pain."
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