Telephone-Delivered Cognitive Behavior Therapy for Chronic Pain

Chronic pain represents an epidemic in the United States and a serious public health problem, particularly among adults over the age of 55. In the Veterans Health Administration (VHA), nearly 50% of patients seen in primary care settings report disabling pain symptoms. Persistent pain in older adults is often associated with disability, emotional distress, and increased health care utilization and cost. Since an increase in the number of older adults is anticipated over the next two decades, the problem of chronic pain in this age group will take on increased importance.

Although cognitive behavior therapy (CBT) aimed at improving coping skills is now commonly employed within interdisciplinary pain management programs, access to these interventions is often limited due to the distance from clinical care and disabling impact of pain. In addition, the dropout rate in studies of face-to-face CBT for chronic pain further detracts from its impact in pain management. A telephone-delivered version of CBT for chronic pain overcomes these barriers to access.

To examine the effectiveness of this approach, a two-arm randomized clinical trial was conducted with 98 individuals, 55 years of age and older, who suffered from chronic pain, recruited from a primary care clinic at the VA Medical Center in San Francisco and affiliated VA Community-based Outpatient Clinics (CBOCs) in Santa Rosa, San Bruno, Ukiah, and Eureka. In Study Arm 1, patients received telephone-based cognitive behavior therapy (T-CBT); and in Study Arm 2, patients received pain education (T-ED) matched with Study Arm 1 for amount of contact time. Patients in both groups received 12 sessions of telephone-based individual therapy over a 20-week period. Pain management outcomes were measured at mid-treatment (10 weeks), post-treatment (20 weeks), and at 3-month (32 weeks) and 6-month (46 weeks) follow-up. Outcome variables included measures of pain symptoms, physical limitations, coping, emotional distress, and health-related quality of life. The study hypothesis, assessment methodology, and intervention procedures were based on the cognitive-behavioral model of chronic pain

Inclusion criteria

Potential subjects must be:

• veterans enrolled in a VA primary care clinic
• at least 55 years of age
• have access to a telephone
• have documented pain for at least the past year
• a pain disorder involving muscle strain and inflammation, trauma to nerves, or central nervous system dysfunction
• Their pain condition must be stable and participants must have no clear indication for specific medical/surgical intervention.

Exclusion criteria

Patients were excluded who were:

• psychotic
• cognitively impaired
• show significant suicidal risk (history of multiple suicide attempts or actively suicidal)
• currently abusing alcohol or other drugs, including prescribed opioid pain medications
• voice impairment that would prevent participation in telephone counseling
• visual impairment that would prevent use of the workbook and completion of assessment materials.
• Patients will also be excluded who have an unstable medical condition and clear indication for specific medical/surgical intervention in the near future.