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Summaries for Patients |3 April 2018

Cognitive Behavioral Therapy Versus Education for Chronic Pain Free

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Author, Article, and Disclosure Information
This article was published at Annals.org on 27 February 2018.

  • The full report is titled “Literacy-Adapted Cognitive Behavioral Therapy Versus Education for Chronic Pain at Low-Income Clinics. A Randomized Controlled Trial.” The authors are B.E. Thorn, J.C. Eyer, B.P. Van Dyke, C.A. Torres, J.W. Burns, M. Kim, A.K. Newman, L.C. Campbell, B. Anderson, P.R. Block, B.J. Bobrow, R. Brooks, T.T. Burton, J.S. Cheavens, C.M. DeMonte, W.D. DeMonte, C.S. Edwards, M. Jeong, M.M. Mulla, T. Penn, L.J. Smith, and D.H. Tucker.


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What is the problem and what is known about it so far?

Chronic pain is a common problem that affects many people who have a low income or are members of minority groups. It is difficult to treat. Cognitive behavioral therapy (CBT) is a form of psychotherapy that teaches people how thoughts, feelings, physical sensations (such as pain), and behaviors are connected, as well as coping skills to help them feel better. Although CBT has been shown to be effective in treating pain, low-income patients with pain may have problems getting this therapy. Furthermore, trials of CBT have not been done with patients from low-income communities.

Why did the researchers do this particular study?

The researchers wanted to compare the effects of CBT, a pain education (EDU) program, and usual care on pain levels in patients who have chronic pain.

Who was studied?

290 adults with chronic pain symptoms. Most had an income at or below the poverty level, and about one third had a reading level below fifth grade. Many participants were taking opioids at the beginning of the study.

How was the study done?

The study participants were randomly assigned to receive CBT, EDU, or usual care. The researchers developed the CBT and EDU programs for adults with limited reading ability. The participants who were assigned to the CBT and EDU programs attended group sessions held once a week for 10 weeks. Participants in all 3 groups answered questionnaires about their pain levels and physical functioning at baseline, 10 weeks, and 6 months.

What did the researchers find?

After the 10 weeks, participants in the CBT and EDU groups had a greater decrease in their pain levels than those in the usual care group, which did not show much change over time. The EDU group still had improved pain levels at 6 months, but the CBT group did not. Both the CBT and EDU groups showed greater improvement in physical functioning than the usual care group at 10 weeks and at 6 months.

What were the limitations of the study?

The researchers could not tell whether the CBT or EDU program resulted in a change in the amount of opioids used by the participants.

What are the implications of the study?

CBT and EDU programs that were simplified for reading ability resulted in improved pain and physical functioning in patients with chronic pain.

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Cognitive Behavioral Therapy Versus Education for Chronic Pain. Ann Intern Med. 2018;168:I–22. [Epub ahead of print 27 February 2018]. doi: https://doi.org/10.7326/P18-0001

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Published: Ann Intern Med. 2018;168(7):I-22.

DOI: 10.7326/P18-0001

Published at www.annals.org on 27 February 2018

©
2018 American College of Physicians
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