Remote programs effective for chronic pain, study finds

Telehealth and online cognitive behavioral therapy could expand treatment options for chronic pain in rural areas

Remotely delivered cognitive behavioral therapy (CBT) is effective in reducing patients’ chronic pain compared with usual care, according to new research. Published in JAMA, the study was conducted by Kaiser Permanente Washington Health Research Institute (KPWHRI) and Kaiser Permanente Center for Health Research (CHR), in collaboration with partner institutions.

CBT is an effective nondrug treatment for chronic pain. It encourages people to identify and challenge thoughts that can make pain worse and offers coping strategies to help people better manage their pain.

However, CBT can be expensive and sometimes isn’t available, especially given national shortages in mental health providers. “In rural communities in particular, CBT and other evidence-based pain interventions, such as acupuncture and chiropractic care, can be hard to come by,” said Andrea Cook, PhD, a biostatistics investigator at KPWHRI who was the senior author of the study. “We wanted to learn whether remotely delivered CBT could be an effective alternative.”

The RESOLVE randomized clinical trial compared 2 modes of remotely delivered CBT services to address patients’ chronic pain:

• A health coach-led approach provided through one-on-one phone or video sessions (telehealth)
• A self-completed online program called painTRAINER

Both 8-session programs aimed to improve pain and functioning for patients with “high-impact chronic pain” — pain lasting 3 months or longer that impacts life or work activities. The researchers compared the effectiveness of both remote programs to each other and to usual care.

The study included adult patients meeting criteria for high-impact chronic pain at 4 health care systems: Essentia Health, serving parts of Minnesota, North Dakota, and Wisconsin; and 3 Kaiser Permanente health care systems serving Georgia, Oregon, and Washington. In total, 2,331 patients — 44% from rural or medically underserved regions of the U.S. — were randomly assigned to one of the two remote CBT programs or to usual care. The usual care group received a mailed resource guide on managing chronic pain in addition to their routine care.

After 3 months, patients having CBT delivered by either remote format were significantly more likely to have a 30% or greater improvement in pain severity than those in the usual care group. Patients in the health coach group were particularly likely to see improvement. Both CBT approaches showed similar sustained benefit through 12 months of follow-up compared with usual care.

The new findings demonstrate that remotely delivered CBT is effective for treating adult patients with high-impact chronic pain. Lead researcher Lynn DeBar, PhD, a CHR distinguished investigator, expressed hope that this research will lead to more patients getting treatment: “Given the lack of available services and cost barriers for many struggling with chronic pain, we hope the study encourages widespread adoption of these potentially more accessible and low-cost options.”

KPWHRI coauthors on the study include Robert Wellman, MS; Ben Balderson, PhD; and Morgan Justice, MA. KPWHRI’s Survey Research Program provided recruitment and data collection for the study.

Adapted from a news story by Jill Pope, senior scientific editor with Kaiser Permanente Center for Health Research.​​​​​