A primary care-based cognitive behavioral therapy intervention for long-term opioid users with chronic pain

DOI: https://doi.org/10.7326/M21-1436

Commentary

The purpose of this study was to determine the effectiveness of a group-based CBT intervention for chronic pain.

Adults (18 years of age and older) with mixed chronic pain conditions who were receiving long-term opioid therapy received a CBT intervention in which a multidisciplinary team (behaviorist, nurse, physical therapist, pharmacist) taught pain self-management skills in 90-minute groups 12 times per week compared to usual care. Self-reported pain impact was assessed quarterly for 12 months, as was pain-related disability, satisfaction with care, and use of opioids and benzodiazepines based on electronic health care data.

As a result, a total of 850 people participated, representing 106 clusters of primary care providers. (Mean age 60.3 years, 67.4% female)

96.0% completed follow-up assessments, and intervention patients maintained significant reductions in all self-reported outcomes from baseline to 12-month follow-up. The change in PEGS score for the impact of pain was -0.434 points (95% CI, -0.690 to -0.178 points), and the change in pain-related disability was -0.060 points (CI, -0.084 to -0.035 points).

At 6 months, intervention patients reported greater satisfaction with primary care (difference, 0.230 points [CI, 0.053 to 0.406 points]) and pain services (difference, 0.336 points [CI, 0.129 to 0.543 points]). Benzodiazepine use was further reduced in the intervention group (absolute risk difference, -0.055 [CI, -0.099 to -0.011]), but opioid use was not significantly different between groups.

Primary care-based CBT, using front-line clinicians, resulted in modest but sustained reductions in measures of pain and pain-related disability compared with usual care, but did not reduce the use of opioid medications.