Self-Directed vs Clinician-Delivered Cognitive Behavioral Therapy for Chronic Pain
Findings from the COPES ExTRA Trial
Background
Chronic pain is common and can have widespread negative effects on physical functioning, ability to engage in activities, mood, quality of life, and sleep. Non-drug treatments, either alone or in combination with other pain treatments, are recommended as a safe and effective way to manage the negative effects of chronic pain. Cognitive behavioral therapy for chronic pain (CBT-CP) is an evidence-based non-drug treatment that is available throughout the VA. Despite its effectiveness, there are barriers to accessing it including scheduling, travel difficulties associated with attending 6-12 treatment sessions, and shortages of trained clinicians, especially in rural areas. Convenient and accessible self-directed treatments that do not require real-time contact with a clinician (no appointment needed) may be a way to provide more people with treatment.
Primary Study
Cognitive behavioral therapy for chronic pain (CBT-CP) is an evidence-based psychological intervention that is effective for reducing pain and improving function for patients with chronic pain. The goal of this project is to conduct a pragmatic trial to examine the real-world effectiveness of an interactive voice response (IVR)-delivered form of Cognitive behavioral therapy for chronic pain (CBT-CP) called Co-operative Pain Education and Self-management (COPES), versus CBT-CP provided by VA clinicians (e.g., in person or via telehealth).
Findings
This clinical trial of 764 veterans with chronic pain was conducted at 9 VA healthcare systems and compared two forms of CBT-CP: self-directed CBT-CP done from home, without appointments, with personalized weekly coach messages, and clinician-delivered CBT-CP done in-person, by video, or telephone with a local VA clinician. Veterans in both treatments improved in terms of pain interference, sleep, symptoms of depression, pain, and ratings of overall benefit from treatment. Veterans receiving the self-directed treatment improved more on each of these measures and remained better up to the last measurement at 12 months. Veterans in the self-directed CBT-CP waited fewer days to start treatment, more of them began treatment, and they completed more weeks of treatment.
Why it Matters
- Self-directed CBT-CP with personalized feedback is effective and convenient and increases access to a non-drug treatment for chronic pain.
- Self-directed CBT-CP can be delivered from a hub to Veterans at any VA location, so each location does not need their own coach.
- In VA, offering self-directed and clinician-delivered CBT-CP increases Veterans’ treatment choices and increased treatment capacity throughout the system particularly at sites where trained clinicians are scarce.