Automated telephone as an adjunct for the treatment of chronic pain: a pilot study

The objective of this study was to test whether Interactive Voice Response (IVR) can be used to enhance the therapeutic outcome of patients receiving group cognitive behavioral therapy (CBT) for chronic pain. Ten subjects with chronic pain syndromes participated in 10 weeks of group CBT followed by 4 months of Therapeutic Interactive Voice Response (TIVR). Our specially designed TIVR is based on a computerized telephone system in which callers are asked questions and respond by using the telephone keypad. It was created to reinforce pain coping skills and to provide messages for relaxation, sleep induction, and emotional support that can be accessed by patients on demand. Within-subject analysis showed that maximum positive change for nearly all outcome measures was observed at the post-TIVR point. For some measures, improvement compared to baseline was significant after TIVR despite the fact it had not been significant after CBT. Measures showing this pattern included SF-36 Mental Health Composite Score (P < .0004), McGill Pain Questionnaire pain (P < .01), Coping Strategies Questionnaire Catastrophizing (P < .0006), Treatment Outcomes in Pain Survey Total Pain Experience (P < .03), and Perceived Family/Social Disability (P < .02). Our preliminary results suggest that TIVR can be used to improve coping skills adherence and to prevent relapse into pain behavior.