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Self-Directed Cognitive Behavioral Therapy for Chronic Pain Save
Is self-directed cognitive behavioral therapy (CBT) when augmented with asynchronous, personalized feedback for chronic pain (CBT-CP) superior to clinician-delivered CBT-CP?
Findings In this pragmatic randomized clinical trial of 764 adults with chronic musculoskeletal pain, self-directed CBT-CP compared with clinician-delivered CBT-CP produced superior but small improvements in pain interference (measured by the interference scale of the Brief Pain Inventory; range, 0-10 [higher score indicates worse function]) at 4 months (mean scores, 5.26 vs 6.23, respectively).
Meaning Self-directed CBT-CP with asynchronous, personalized feedback provided an effective alternative to clinician-delivered CBT-CP under usual practice conditions.
Abstract
JAMA has published a pragmatic trial wherein cognitive behavioral therapy (CBT) was show to be effective in managing chronic pain (CBT-CP), with a modest advantage to patient self-directed CBT-CP compared to clinician-delivered CBT-CP.
This randomized, open-label pragmatic superiority trial enrolled 764 patients with chronic musculoskeletal pain from 9 US Veterans Health Administration (VHA) health care systems (2019 to 2024). Patients were randomized to either self-directed CBT-CP (n = 384) or clinician-delivered CBT-CP (n = 380) for 11 weeks. The primary outcome was patient-reported pain 4 months (score range, 0-10).
Of the 764 randomized, 583 participants (76%) completed the 4-month assessment and 523 (68%) the 12-month assessment.
At 4 months, the self-directed CBT-CP was superior to clinician-delivered CBT-CP for reduction in pain interference (mean score, 5.26 vs 6.23, P < .001) and maintained superiority at 6 and 12 months. Self-directed CBT-CP was superior to clinician-delivered CBT-CP for all other outcomes at 4 months (P ≤ .001). Participants in the self-directed CBT-CP group completed more expected treatment sessions than patients in the clinician-delivered CBT-CP group.
Self-directed CBT is scalable, convenient and empowering for patients - might this increase uptake of CBT-CP?
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Disclosures
The author has no conflicts of interest to disclose related to this subject
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