Primary care-based CBT eases pain, pain-related disability, but not opioid use

A primary care-based cognitive behavioural therapy (CBT) delivered by frontline clinicians results in modest but sustained reductions in pain and pain-related disability relative to usual care, reports a study. However, the intervention does not appear to reduce the use of opioid medication.

This pragmatic, cluster randomized controlled trial enrolled adults with mixed chronic pain conditions receiving long-term opioid therapy. Participants were randomly assigned to a CBT intervention teaching pain self-management skills in 12 weekly, 90-minute groups delivered by an interdisciplinary team (ie, behaviourist, nurse, physical therapist, and pharmacist) or to usual care.

Of the 850 participants that represented 106 clusters of primary care providers (mean age 60.3 years, 67.4 percent women), 816 (96.0 percent) completed follow-up assessments.

Patients in the intervention group had greater reductions on all self-reported outcomes from baseline to 12-month follow-up than those in the usual care group: change in pain intensity and interference with enjoyment of life, general activity, and sleep (PEG) score, –0.434 point (95 percent confidence interval [CI], –0.690 to –0.178) for pain impact; change in pain-related disability, –0.060 point (95 percent CI, –0.084 to –0.035).

Intervention patients also reported higher satisfaction with primary care (difference, 0.230 point, 95 percent CI, 0.053–0.406) and pain services (difference, 0.336, 95 percent CI, 0.129–0.543) at 6 months.

Notably, there was a greater decrease in benzodiazepine use in the intervention group (absolute risk difference, –0.055, 95 percent CI, –0.099 to –0.011), but no significant between-group difference was observed with opioid use.

This study was limited by the inclusion of only patients with insurance in large integrated healthcare systems and the unclear clinical effect of change in scores.