Online CBT improved high-impact chronic pain
Telephone/videoconference cognitive behavioral therapy (CBT)-based chronic pain treatment with a health coach led to a clinically significant reduction in chronic pain severity compared to usual care, a trial found.
For patients with high-impact chronic pain, telehealth and online cognitive behavioral therapy (CBT)-based chronic pain treatments resulted in at least 30% improvement in pain and related functional and quality-of-life outcomes compared with usual care, a study found.
Researchers recruited 2,331 patients with high-impact chronic musculoskeletal pain into a comparative effectiveness phase 3 trial. Patients were enrolled from four geographically diverse U.S. health care systems between January 2021 and February 2023 and randomized 1:1:1 to an eight-session, CBT-based training program led by a health coach via telephone/videoconferencing, an online, self-completed CBT-based program (painTRAINER), or usual care plus a resource guide.
The primary outcome was the minimal clinically important difference in pain severity score (≥30% decrease; score range, 0 to 10) on the 11-item Brief Pain Inventory-Short Form from baseline to three months, with secondary time points of six and 12 months. Secondary outcomes at all three time points included pain intensity, pain-related interference, patient-reported social role and physical functioning, and patient global impression of change. Results were published July 23 by JAMA.
Of 2,331 eligible randomized individuals, 2,210 (94.8%) completed the trial. At three months, the adjusted percentage of participants achieving a 30% or greater decrease in pain severity score was 32.0% (95% CI, 29.3% to 35.0%) in the health coach group, 26.6% (95% CI, 23.4% to 30.2%) in the painTRAINER group, and 20.8% (95% CI, 18.0% to 24.0%) in the usual care group. Both intervention groups were significantly more likely to attain a clinically important difference in pain severity compared with control (relative risk [RR], 1.54 [95% CI, 1.30 to 1.82] for health coach vs. usual care and 1.28 [95% CI, 1.06 to 1.55] for painTRAINER vs. usual care) The health coach program was more effective than the online self-completed painTRAINER program (RR, 1.20; 95% CI, 1.03 to 1.40). Statistically significant benefits were observed for both intervention groups versus usual care at six and 12 months after randomization for the pain severity outcomes and for other secondary outcomes of pain and functioning.
The study authors noted that use of these lower-resource CBT treatments could improve availability of evidence-based nonpharmacologic pain treatments within health care systems.
“Findings suggest that centralizing delivery of the CBT-[chronic pain] 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.