New Study Examines Cognitive Behavioral Therapy as Chronic Pain Treatment

Lynn DeBar, PhD, MPH

A team of investigators led by Lynn DeBar, PhD, MPH, Kaiser Permanente Washington Health Research Institute, found that primary care-based cognitive behavioral therapy (CBT) had a modest, sustained effect in reducing pain and pain-related disability compared with usual care. It did not reduce the use of opioid medication.

The Motivation

Chronic pain is a pervasive problem in many populations. Not only is it debilitating but it can be expensive to treat.

Investigators wanted to examine the effect of cognitive behavioral therapy interventions in patients receiving long-term opioid therapy for chronic pain because there have been few clinical trials conducted.

The focus of the study was determining the effectiveness of a group-based cognitive behavioral therapy intervention for chronic pain. Investigators were looking to see if cognitive behavioral therapy would help reduce the use of opioid medication.

The Study

This pragmatic, cluster randomized controlled trial included 850 adult patients with mixed chronic pain conditions. The patients had been receiving long-term opioid therapy.

A cognitive behavioral therapy intervention including pain self-management skills was taught to the patients over 12 weekly, 90-minute groups by an interdisciplinary team. The control group received usual care.

Self-reported pain levels were measured by the pain intensity and interference with enjoyment of life, general activity, and sleep (PEGS) scale. The reports were assessed by investigators quarterly over 12 months for the primary outcome.

Secondary outcomes were pain-related disability, satisfaction with care, and opioid and benzodiazepine use based on electronic health care data.

The Results

Within the 850 patients, 106 clusters of primary care providers were represented. The mean age was 60.3 years and 67.4% were women. Follow-up assessments were completed by 816 patients or 96%.

On all self-reported outcomes, intervention patients sustained larger reductions from baseline to 12-month follow-up. The difference in the PEGS score for pain impact was -0.434 point. For pain-related disability the change was -0.060 point.

Intervention patients reported higher satisfaction with primary care at 6 months with the difference being 0.230 point. Higher satisfaction with pain services was also reported at 6 months with the difference being 0.336 point.

The use of benzodiazepine decreased more in the intervention group, however, opioid use showed no significant difference between the 2 groups.

Overall, the results showed subtle, sustained reductions in pain and pain-related disability compared to the control group but not enough of a difference in terms of opioid use.

Investigators noted that only patients with insurance who were receiving treatment in a large integrated health care system were included and could be a limitation. Generalizability was limited and the clarity of the clinical effect of change in scores was lacking.

The study, “A Primary Care-Based Cognitive Behavioral Therapy Intervention for Long-Term Opioid Users with Chronic Pain” was published in Annals of Internal Medicine.