Telehealth and Online CBT for High-Impact Chronic Pain

Key Takeaways

• Both remote 8-session CBT-based programs were associated with higher 3-month clinically important pain response rates than usual care.
• The health coach-led program showed better primary endpoint performance than the self-completed online painTRAINER program.
• Benefits were also reported at 6 and 12 months for pain severity and functional outcomes, and the authors characterized the overall effects as modest.

In adults with high-impact chronic musculoskeletal pain, a randomized clinical trial found a 32.0% adjusted 3-month response rate with telehealth health coach-led CBT-based treatment, compared with a self-completed online CBT-based program and with usual care plus a resource guide. The health coach-led approach showed the strongest primary effect among the three groups, and both remote CBT-based approaches outperformed usual care on the primary pain response measure.

The study evaluated remote CBT-based care in a comparative effectiveness, 3-group, phase 3 randomized clinical trial. Investigators enrolled 2,331 eligible adults from 4 geographically diverse U.S. health care systems between January 2021 and February 2023. Participants were assigned 1:1:1 to health coach-led CBT-CP by telephone or videoconferencing, self-completed online painTRAINER, or usual care plus a resource guide. Both active groups received 8-session remote skills training, and outcomes were assessed at 3 months, with follow-up at 6 and 12 months.

The primary endpoint was clinically important pain improvement, defined as at least a 30% reduction in pain severity score on the 11-item Brief Pain Inventory-Short Form from baseline to 3 months. Adjusted response rates were 32.0% for health coach, 26.6% for painTRAINER, and 20.8% for usual care. Both intervention groups were significantly more likely than usual care to reach that endpoint, with relative risks of 1.54 and 1.28, respectively. The health coach program also outperformed painTRAINER, with a relative risk of 1.20, making it the strongest primary performer.

Benefits extended beyond the primary time point in both intervention groups. Secondary outcomes assessed at 3, 6, and 12 months included pain intensity, pain-related interference, PROMIS social role, PROMIS physical functioning, and patient global impression of change. Statistically significant benefits versus usual care were reported at 6 and 12 months for pain severity and other secondary pain and functioning outcomes, although numeric estimates and itemized results for each secondary measure were not provided in the abstract. The reported 6- and 12-month pain and function outcomes extended beyond the initial 3-month assessment.

Among all randomized participants, 2,210 individuals, or 94.8%, completed the trial. The abstract does not describe adverse events or safety outcomes. Participant characteristics included a mean age of 58.8 years, 74% women, and 44% from rural or medically underserved settings. The authors characterized the improvements as modest and said these lower-resource treatments could improve availability of evidence-based nonpharmacologic pain treatments within health care systems.