Cognitive behavioural therapy helps in high-impact chronic pain

In the treatment of individuals with high-impact chronic pain, scalable cognitive behavioural therapy (CBT)-based treatments appear to produce modest improvements in pain and related functional/quality-of-life outcomes relative to usual care, according to a study.

The study included 2,331 patients (mean age 58.8 years; 1,712 [74 percent] women; 1,030 [44 percent] rural/medically underserved) with high-impact chronic musculoskeletal pain, enrolled from four US healthcare systems said to be geographically diverse. These patients were randomly assigned to undergo remote, eight-session, CBT-based skills training treatments that were either delivered via telephone/videoconferencing and led by a health coach (n=778) or delivered online via a self-completed program (painTRAINER; n=776) or to receive usual care plus a resource guide (n=777).

The primary outcome was achievement or exceeding the minimal clinically important difference (MCID) in pain severity score (≥30-percent decrease; score range, 0–10) on the 11-item Brief Pain Inventory–Short Form from baseline to 3 months. The scores were also assessed at 6 and 12 months from baseline as secondary time points. Other outcomes evaluated were pain intensity, pain-related interference, Patient-Reported Outcomes Measurement Information System (PROMIS) social role and physical functioning, and patient global impression of change.

Of the patients, 2,210 (94.8 percent) completed the trial. At 3 months, the adjusted percentage of participants achieving MCID in pain severity score was significantly higher in the CBT-based treatments, at 32.0 in the health coach group and 26.6 in the painTRAINER group vs 20.8 in the usual care group.

Both CBT-based intervention groups were significantly more likely to attain an MCID in pain severity compared with the usual care group (health coach vs usual care: relative risk [RR], 1.54, 95 percent confidence interval [CI], 1.30–1.82; painTRAINER vs usual care: RR, 1.28, 95 percent CI, 1.06–1.55). Furthermore, the health coach program had a greater effect than the online self-completed painTRAINER program (health coach vs painTRAINER: RR, 1.20, 95 percent CI, 1.03–1.40).

Pain severity outcomes and other secondary pain and functioning outcomes at 6 and 12 months were significantly improved in both CBT-based intervention groups vs usual care group.