Pain, Quality of Life May Be Improved By Interactive Therapy

Patients with chronic back pain who received interactive voice response-based cognitive behavioral therapy (IVR-CBT) experienced similar beneficial outcomes as patients who received in-person cognitive behavioral therapy (CBT), according to a recent study.

The randomized trial included 125 patients with chronic back pain from the Department of Veterans Affairs health care system. Twenty-eight of the participants were women, 97 were men, and the mean age was 57.9 years.
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A total of 62 patients were assigned to IVR-CBT, which included a self-help manual and weekly prerecorded therapist feedback based on the patient’s IVR-reported activity, coping skill practice, and pain outcomes. The remaining 63 patients were assigned to in-person CBT, which included weekly individual sessions with a therapist. Throughout the study, all patients received IVT monitoring of pain, sleep activity levels, and pain coping skill practice.

Changes in average pain intensity from baseline to 3 months, which was measured by the Numeric Rating Scale (NRS), was assessed as the primary outcome. The secondary outcomes included changes in pain-related interference, physical and emotional functioning, sleep quality, and quality of life at 3, 6 and 9 months. In addition, the researchers also assessed treatment retention.

Overall, the adjusted average reduction in NRS for patients assigned to IVR-CBT was similar to patients assigned to in-person CBT, and both treatments showed statistically significantly improvements in physical functioning, sleep quality, and physical quality of life at 3 months. While there was no advantage for either treatment for both primary and secondary outcomes, the researchers did find that patients assigned IVR-CBT had a lower dropout rate and completed on average 2.3 more sessions compared with patients assigned in-person CBT.

“IVR-CBT is a low-burden alternative that can increase access to CBT for chronic pain and shows promise as a nonpharmacologic treatment option for chronic pain, with outcomes that are not inferior to in-person CBT,” the researchers concluded.

—Melissa Weiss

Reference:

Heapy AA, Higgins DM, Goulet JL, et al. Interactive voice response-based self-management for chronic back pain: the COPES Noninferiority Randomized Trial. JAMA Intern Med. 2017; 177(6):765-773.