Two chronic pain treatments based on cognitive behavioral therapy (CBT) — telehealth coaching and online self-completed pain coping skills training — improved pain severity and quality of life compared to usual care in patients with high-impact chronic pain, according to a recent study published in JAMA.
“The evidence from this study can help clinical practices justify and move forward with offering remote pain coping skills training that is based on recommended cognitive behavioral therapy interventions. We hope to see that more people with chronic pain will have access to pain coping skills training in the future, and perhaps a choice of whether they would like to complete it on their own, at home, or by phone or video conference with a health coach,” said Christine Rini, PhD, professor of Medical Social Sciences in the Divisions of Intervention Science and Implementation Science, who was a co-author of the study.
According to the Centers for Disease Control and Prevention, approximately one in 10 U.S. adults currently experiences high-impact chronic pain, or pain that lasts three months or longer and limits activity in work and everyday life.
Patients are typically treated with a multidisciplinary care approach, which include CBT-based therapies that teach relaxation, distraction and other pain coping techniques. However, many patients do not have access to these treatments, especially for those in rural areas where pain-related disability and depression are more common than in urban areas, according to Rini.
“Unfortunately, it’s difficult for most people to access pain coping skills training. Traditionally, it is delivered by trained psychologists and requires other resources that many treatment centers don’t have,” said Rini, who is also a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
To address this care gap, Rini and her collaborators developed a free self-completed, online training program called painTRAINER to help make pain coping skills training more accessible for individuals with chronic pain, including people with high-impact chronic pain.
To evaluate the effectiveness of the program, more than 2,300 patients with high-impact chronic pain from healthcare systems across the U.S. were randomized to complete one of the following CBT-based skills training treatments over the course of eight sessions: working with a health coach via phone or videoconferencing to learn pain coping skills, using painTRAINER to learn pain coping skills on their own, at home, or usual care plus a resource guide.
Participants also completed a baseline questionnaire before they were randomized and three follow-up questionnaires at three, six, and 12 months.
“We compared the percentage of people in each group that achieved what we call a ‘minimal clinically important improvement’ in their pain severity score. That is, we wanted to see how many people had a meaningful, noticeable improvement in pain severity, which included both the intensity of their pain and interference their pain caused in their daily life,” Rini said.
The investigators found that participants who used either of these two programs were more likely to achieve meaningful pain improvement compared to usual care. At the three-month follow up, more participants in the health coach program achieved at least 30 percent improvement in pain severity compared to participants in the painTRAINER program. However, by six and 12 months, the health coach and painTRAINER groups showed similar improvements in pain severity, and both remained superior to usual care.
“We found a very similar pattern of results for improvements in physical functioning and social role functioning, as well. So, the pain benefits of painTRAINER and the health coach program extended to important experiences in daily life,” Rini said.
The findings support the implementation of these remote CBT chronic pain programs for treating patients with high-impact chronic pain, especially for those in rural areas.
Looking ahead, Rini said her team aims to compare the cost effectiveness of the two programs compared to usual care so that they can be offered by clinical practices more widely.
“Those analyses will provide additional justification for moving forward with plans to offer these programs more widely, and perhaps inform reimbursement decision-making. We also hope to determine whether there are subgroups of people with chronic pain who do better when they use one or the other of the two effective pain coping skills programs that we tested,” Rini added.
This research was supported by the National Institutes of Health through the NIH HEAL Initiative under UG3AG067493/UH3AG067493.
Learn more about painTRAINER below:
