Brief cognitive behavioral therapy for chronic pain rapidly improves pain interference: a randomized controlled trial

ABSTRACT: Abbreviated psychotherapies for chronic pain improve access to care by reducing length of treatment and reaching patients outside of chronic pain clinics, such as primary care. However, the evidence for these approaches is limited. We conducted a randomized controlled trial of brief cognitive behavioral therapy for chronic pain (ie, 6, 30-minute sessions of psychoeducation, behavioral and cognitive skills, and relapse prevention delivered individually) with 184 primary care patients with moderate to severe chronic musculoskeletal pain from a Veterans Health Administration medical center. Mean age of the sample was 59 years (SD = 13.3), 84.8% were male, and 77.2% were White. Following baseline, patients were randomized to either brief cognitive behavioral therapy for chronic pain plus usual pain care or usual pain care alone. Assessments were conducted at baseline plus 6 weeks (mid-treatment), 12 weeks (treatment completion), and 24 weeks (3 month post-treatment follow-up) to gather information regarding pain interference (primary outcome), pain intensity, mental health symptoms, quality of life, and social role participation. Results indicated that relative to usual pain care alone, participants who also received behavioral treatment showed statistically greater improvement in pain interference at each time point. Clinically significant improvement in pain interference was reached by mid-treatment with continued improvement at treatment completion and 3-month follow-up among the behavioral treatment group but not the usual pain care group. Behavioral treatment was also associated with improved physical quality of life and sleep quality. This significantly abbreviated behavioral treatment designed for scalability can lead to rapid and sustained improvements in pain outcomes.