Remote chronic behavioral therapy improves chronic pain symptoms and quality-of-life: JAMA
A new study published in the Journal of American Medical Association showed that when compared to standard therapy, remote, scalable cognitive behavioral therapy skills training programs for chronic pain (CBT-CP) therapies (either through telehealth or self-completed online courses) produced moderate reductions in pain and associated functional/quality-of-life outcomes in people with high-impact chronic pain.
Although they are not generally available, cognitive behavioral therapy (CBT) skills training programs are advised as the initial nonpharmacologic treatment for chronic pain. Thus, this study was set to evaluate the efficacy of telehealth and self-completed online remote, scalable CBT-CP therapies with standard care for those with high-impact chronic pain.
From January 2021 to February 2023, 2331 eligible individuals with high-impact chronic musculoskeletal pain from four geographically disparate US health care systems participated in this comparative efficacy, 3-group, phase 3 randomized clinical research. The period of follow-up ended in April 2024.
The participants were randomly assigned 1:1:1 to one of two remote, 8-session CBT-based skills training treatments: normal care with a resource guide (n = 777) or a health coach-led program via videoconference or phone (health coach; n = 778) or an online self-completed program (painTRAINER; n = 776).
Achieving or surpassing the minimum clinically meaningful difference (MCID) in pain intensity score (≥30% drop; score range, 0-10) on the 11-item Brief Pain Inventory–Short Form between baseline and 3 months was the main goal. Pain severity, pain-related interference, PROMIS (Patient-Reported Outcomes Measurement Information System) social role and physical functioning, and the patient's overall perception of change were secondary outcomes at 3, 6, and 12 months.
A total of 2,210 (94.8%) of the 2,331 eligible randomized participants finished the trial. The adjusted proportion of individuals who experienced a 30% or more reduction in their pain severity score at 3 months was 26.6 (95% CI, 23.4-30.2) in the painTRAINER group, 20.8 (95% CI, 18.0-24.0) in the usual care group, and 32.0 (95% CI, 29.3-35.0) in the health coach group.
The relative risk [RR] for both intervention groups was 1.54 [95% CI, 1.30-1.82] when compared to the control group. The RR for painTRAINER versus usual care was 1.28 [95% CI, 1.06-1.55]; and the RR for the health coach program was 1.20 [95% CI, 1.03-1.40] when compared to the online self-completed painTRAINER program.
At 6 and 12 months following randomization, both intervention groups showed statistically significant improvements in pain severity outcomes as well as various secondary pain and functional outcomes as compared to conventional treatment. Overall, the results indicate that centralizing the delivery of CBT-CP-based programs using online interventions and telephone/videoconferencing is successful.
Reference:
DeBar, L. L., Mayhew, M., Wellman, R. D., Balderson, B. H., Dickerson, J. F., Elder, C. R., Justice, M., Keefe, F. J., McMullen, C. K., Owen-Smith, A. A., Rini, C., Von Korff, M., Waring, S., Yarava, A., Shen, Z., Thompson, R. E., Clark, A. E., Casper, T. C., & Cook, A. J. (2025). Telehealth and online cognitive behavioral therapy-based treatments for high-impact chronic pain: A randomized clinical trial: A randomized clinical trial. JAMA: The Journal of the American Medical Association. https://doi.org/10.1001/jama.2025.11178
