Cognitive behavioral therapy (CBT) and supportive care psychotherapy, both delivered by nurses over the telephone, may offer comparable benefits for the management of chronic back pain, according to a randomized study published in the Journal of Pain.
Veterans with nonspecific low back pain experienced on a daily basis for ≥6 months (pain intensity ≥4/10 on a 10-point numeric rating scale) were recruited for this study.
Study participants were assigned to receive CBT (n=30) or supportive care psychotherapy (n=31). Both treatments consisted of 12 sessions, with an initial face-to-face 2-hour session, followed by 11 30-mintue sessions delivered over the telephone twice weekly for the first 4 weeks and once weekly for the remaining 3 weeks.
CBT sessions consisted of education focused on behavior change and self-management of pain, and the supportive care sessions focused on active listening to patient concerns. Those in the supportive care group also received the standard The Back Pain Help Book.
In patients receiving telehealth CBT and supportive care, there were improvements from baseline to 8 weeks in disability, as indicated by reduced Roland Morris Disability Questionnaire scores (CBT: 11.4±5.9 vs 9.4±6.1, respectively; P <.05; supportive care: 11.1±5.4 vs 9.1±5., respectively; P <.05), in pain levels, as indicated by reduced numeric rating scale scores (CBT: 4.9±2.1 vs 4.0±1.9, respectively; P <.05; supportive care: 5.0±1.9 vs 3.8±2.1, respectively; P <.05), and an improved perception of the condition, as indicated by higher Patient Global Impressions Scale scores (with 39.1% and 26.7% reporting perceiving their condition as “much improved” or “very much improved” for CBT and supportive care, respectively). Treatment satisfaction was comparable in both groups.
Limitations of this study include a small sample size and the lack of a usual care or untreated control arm.
“This article describes the benefits of training primary care nurses to deliver evidence-based behavioral therapies for low back pain,” concluded the study authors. “Due to the high prevalence of chronic pain and the growing emphasis on non-opioid therapies, training nurses to provide behavior therapies could be a cost-effective way to improve pain management.”
Rutledge T, Atkinson JH, Holloway R, et al. Randomized controlled trial of nurse-delivered cognitive behavioral therapy versus supportive psychotherapy telehealth interventions for chronic back pain [published online April 16, 2018]. J Pain. doi: 10.1016/j.jpain.2018.03.017