Cognitive behavior therapy may help reduce chronic pain but not opioid use

The prevalence of chronic pain (CP) is well described in Europe, America, and Australia. However, little knowledge is available of the prevalence of CP within Asia or Southeast Asia. Cognitive Behavioral Therapy (CBT) interventions in primary care to improve chronic pain among those receiving long-term opioid therapy have been reported by few trials.

A randomized controlled trial by Dr Lynn De Bar, PhD, MPH and team revealed that primary care based CBT, using frontline clinicians, produced modest but sustained reductions in measures of pain and pain-related disability compared with usual care but did not reduce use of opioid medication.

The findings of the study are published in Annals of Internal Medicine.

The objective of the study was to determine the effectiveness of a group-based CBT intervention for chronic pain.

The study was a pragmatic, cluster randomized controlled trial that included Adults (aged ≥18 years) with mixed chronic pain conditions receiving long-term opioid therapy. A CBT intervention teaching pain self-management skills in 12 weekly, 90-minute groups delivered by an interdisciplinary team versus usual care. Primary outcome, as measured by the PEGS scale pain intensity and interference with enjoyment of life, general activity, and sleep was assessed quarterly over 12 months. Pain-related disability, satisfaction with care, and opioid and benzodiazepine use based on electronic health care data were secondary outcomes.

The results of the study were

• A total of 850 patients participated, representing 106 clusters of primary care providers (mean age, 60.3 years; 67.4% women); 816 (96.0%) completed follow-up assessments.

• Intervention patients sustained larger reductions on all self-reported outcomes from baseline to 12-month follow-up; the change in PEGS score was −0.434 point (95% CI, −0.690 to −0.178 point) for pain impact, and the change in pain-related disability was −0.060 point (CI, −0.084 to −0.035 point).

• At 6 months, intervention patients reported higher satisfaction with primary care (difference, 0.230 point [CI, 0.053 to 0.406 point]) and pain services (difference, 0.336 point [CI, 0.129 to 0.543 point]).

• Benzodiazepine use decreased more in the intervention group (absolute risk difference, −0.055 [CI, −0.099 to −0.011]), but opioid use did not differ significantly between groups.

Dr De Bar and team concluded that "Primary care–based CBT, using frontline clinicians, produced modest but sustained reductions in measures of pain and pain-related disability compared with usual care but did not reduce use of opioid medication."

Reference: https://doi.org/10.7326/M21-1436