Self-directed CBT a viable alternative to clinician-delivered CBT for chronic pain

Self-directed cognitive behavioural therapy (CBT) for chronic pain (CBT-CP) yields modest improvements in pain interference when compared with clinician-delivered CBT-CP, according to a study.

Researchers conducted an open-label pragmatic superiority trial involving 764 patients (mean age 52.8 years, 39.1 percent female, 39.1 percent Black) with chronic musculoskeletal pain. These patients were randomly assigned to undergo self-directed CBT-CP (n=384) or clinician-delivered CBT-CP (n=380).

Self-directed CBT-CP included 11 weeks of treatment with weekly personalized audio-recorded feedback provided by coaches. Feedback was based on the patients’ daily reports of pain coping skill practice, physical activity, and pain-relevant ratings collected by the interactive voice response system. Clinician-delivered CBT-CP included 4–11 weekly sessions provided under usual practice conditions.

The primary outcome of patient-reported pain interference was assessed using the 7-item Brief Pain Inventory-Interference (BPI-I) subscale at 4 months. Secondary outcomes included BPI-I at 6 and 12 months; pain intensity, pain impact, catastrophizing, self-efficacy, sleep, global impression of change, depressive symptoms at 4 months; and treatment dose.

At 4 months, pain interference was modestly but significantly lower in the self-directed CBT-CP group than the clinician-delivered CBT-CP group (mean BPI-I score, 5.26 vs 6.23; p<0.001). This superiority was maintained through 6 and 12 months.

Results for secondary outcomes also favoured self-directed CBT-CP over clinician-delivered CBT-CP (p≤0.001).

Compared with patients in the clinician-delivered CBT-CP group, those in the self-directed CBT-CP group completed more expected treatment sessions.

The findings suggest that self-directed CBT may be an efficacious alternative to clinician-delivered CBT that could increase uptake of CBT-CP, the researchers said.