CBT vs Pain Education for Chronic Pain in Low-Income Clinics

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Patients were assigned to receive group sessions of 10 weekly 90-minute cognitive behavioral therapy or pain education, or usual care.
Patients were assigned to receive group sessions of 10 weekly 90-minute cognitive behavioral therapy or pain education, or usual care.

Group cognitive behavioral therapy (CBT) and pain education may be more effective than usual care for improving pain and physical function in patients who have chronic pain and are seen at low-income clinics, according to findings from a randomized controlled trial published in the Annals of Internal Medicine.

Adult patients between the ages of 19 and 71 who had mixed chronic pain were enrolled in this study (n=290; 70.7% women). Of the participants, 72.4% were at or below the poverty level.

Patients were assigned to receive group sessions of 10 weekly 90-minute CBT sessions (n=95), pain education (n=97), or usual care (n=98). Study participants were asked to report postinterventional pain intensity and levels of physical function and depression. A total of 241 participants completed the posttreatment assessments. 

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At 10 weeks, participants who received the CBT and pain education interventions experienced greater reductions in pain intensity scores from baseline than those who received usual care (estimated differences in change scores: CBT: -0.80; 95% CI, -1.48 to -0.11; P =.022; pain education: -0.57; 95% CI, -1.04 to -0.10; P =.018). Treatment effects were sustained at 6 months in participants in the pain education group but not in those in the CBT group.

Study participants in both the CBT and pain education groups had greater improvements in physical function at 10 weeks compared with those receiving usual care (estimated differences: CBT: 1.36; 95% CI, 2.11-0.61; P <.001; pain education: 0.70; 95% CI, 1.31-0.09; P <.001), a benefit that was maintained at 6 months after treatment. Changes in depression scores from baseline to 10 weeks were comparable in all 3 groups (estimated differences: CBT: 1.33; 95% CI, 3.02-0.35; P =.120; pain education: 1.15; 95% CI, 2.71-0.41; P =.147).

Considering this study examined patients receiving care within a single healthcare system, the findings may not generalize to other systems. In addition, participants' self-report of symptom changes may have resulted in limited findings.

“As an intervention involving less expense, time, and effort on the part of patients and staff, pain education (as compared with CBT) may be an effective alternative, or it might be used as part of a stepped-care approach before CBT,” concluded the study authors.

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Reference

Thorn BE, Eyer JC, Van Dyke BP, et al. Literacy-adapted cognitive behavioral therapy versus education for chronic pain at low-income clinics: a randomized controlled trial [published online February 27, 2018]. Ann Intern Med. doi: 10.7326/M17-0972

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