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Interactive Voice Response-Based Self-management for Chronic Back Pain: The COPES Noninferiority Randomized Trial
Alicia A Heapy1, Diana M Higgins2, Joseph L Goulet1
1VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven2Yale School of Medicine, New Haven, Connecticut.
JAMA Internal Medicine
|April 7, 2017
Summary
Interactive voice response-based cognitive behavioral therapy (IVR-CBT) is a viable, noninferior alternative to in-person CBT for chronic back pain. This low-burden approach increases access to effective pain management strategies.
Area of Science:
- Pain Management
- Behavioral Health Technology
- Clinical Trials
Background:
- Chronic pain management emphasizes multimodal, nonpharmacologic strategies like cognitive behavioral therapy (CBT).
- Access to in-person CBT is limited by persistent barriers.
- Health technology-assisted CBT delivery offers a potential solution, but its efficacy is unproven.
Purpose of the Study:
- To evaluate the efficacy of interactive voice response-based CBT (IVR-CBT) compared to traditional in-person CBT for chronic back pain.
- To determine if IVR-CBT is noninferior to in-person CBT in managing pain intensity.
Main Methods:
- A randomized, noninferiority trial (Cooperative Pain Education and Self-management [COPES] trial) was conducted.
- 125 patients with chronic back pain were allocated to either IVR-CBT or in-person CBT.
- Outcomes included changes in pain intensity (Numeric Rating Scale), pain interference, functioning, and quality of life.
Main Results:
- IVR-CBT demonstrated noninferiority to in-person CBT, with similar reductions in pain intensity (IVR-CBT: -0.77, in-person CBT: -0.84).
- Both groups showed significant improvements in physical functioning, sleep quality, and quality of life at 3 months.
- Treatment retention was higher in the IVR-CBT group, with fewer dropouts.
Conclusions:
- Interactive voice response-based CBT (IVR-CBT) is a low-burden, effective nonpharmacologic treatment for chronic pain.
- IVR-CBT increases access to CBT and offers comparable outcomes to in-person delivery.
- This technology-assisted approach shows promise for expanding chronic pain self-management options.