TY - JOUR
KW - Adult
KW - Aged
KW - Analgesics, Opioid/therapeutic use
KW - Chronic Pain/drug therapy
KW - cognitive behavioral therapy
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Opioid-Related Disorders/psychology/therapy
KW - Pain Measurement
KW - Primary Health Care
KW - self-management
AU - L. Debar
AU - M. Mayhew
AU - L. Benes
AU - A. Bonifay
AU - R. A. Deyo
AU - C. R. Elder
AU - F. J. Keefe
AU - M. C. Leo
AU - C. McMullen
AU - A. Owen-Smith
AU - D. H. Smith
AU - C. M. Trinacty
AU - W. M. Vollmer
A1 - 
AB - BACKGROUND: Chronic pain is common, disabling, and costly. Few clinical trials have examined cognitive behavioral therapy (CBT) interventions embedded in primary care settings to improve chronic pain among those receiving long-term opioid therapy. OBJECTIVE: To determine the effectiveness of a group-based CBT intervention for chronic pain. DESIGN: Pragmatic, cluster randomized controlled trial. (ClinicalTrials.gov: NCT02113592). SETTING: Kaiser Permanente health care systems in Georgia, Hawaii, and the Northwest. PARTICIPANTS: Adults (aged ≥18 years) with mixed chronic pain conditions receiving long-term opioid therapy. INTERVENTION: A CBT intervention teaching pain self-management skills in 12 weekly, 90-minute groups delivered by an interdisciplinary team (behaviorist, nurse, physical therapist, and pharmacist) versus usual care. MEASUREMENTS: Self-reported pain impact (primary outcome, as measured by the PEGS scale [pain intensity and interference with enjoyment of life, general activity, and sleep]) was assessed quarterly over 12 months. Pain-related disability, satisfaction with care, and opioid and benzodiazepine use based on electronic health care data were secondary outcomes. RESULTS: A total of 850 patients participated, representing 106 clusters of primary care providers (mean age, 60.3 years; 67.4% women); 816 (96.0%) completed follow-up assessments. Intervention patients sustained larger reductions on all self-reported outcomes from baseline to 12-month follow-up; the change in PEGS score was -0.434 point (95% CI, -0.690 to -0.178 point) for pain impact, and the change in pain-related disability was -0.060 point (CI, -0.084 to -0.035 point). At 6 months, intervention patients reported higher satisfaction with primary care (difference, 0.230 point [CI, 0.053 to 0.406 point]) and pain services (difference, 0.336 point [CI, 0.129 to 0.543 point]). Benzodiazepine use decreased more in the intervention group (absolute risk difference, -0.055 [CI, -0.099 to -0.011]), but opioid use did not differ significantly between groups. LIMITATION: The inclusion of only patients with insurance in large integrated health care systems limited generalizability, and the clinical effect of change in scores is unclear. CONCLUSION: Primary care-based CBT, using frontline clinicians, produced modest but sustained reductions in measures of pain and pain-related disability compared with usual care but did not reduce use of opioid medication. PRIMARY FUNDING SOURCE: National Institutes of Health.
AD - Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.D.).; Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.).; Kaiser Permanente Center for Health Research, Portland, Oregon, and Montana State University College of Nursing, Missoula, Montana (L.B.).; Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.).; Oregon Health & Science University School of Medicine, Portland, Oregon (R.A.D.).; Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.).; Duke University School of Medicine, Durham, North Carolina (F.J.K.).; Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.).; Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.).; Georgia State University School of Public Health and Kaiser Permanente Center for Clinical and Outcomes Research, Atlanta, Georgia (A.O.).; Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.).; The Queen's Medical Center, Honolulu, Hawaii (C.M.T.).; Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.).
BT - Annals of Internal Medicine
C5 - Education & Workforce; Healthcare Disparities; Measures; Opioids & Substance Use
CP - 1
CY - United States
DO - 10.7326/M21-1436
IS - 1
JF - Annals of Internal Medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Chronic pain is common, disabling, and costly. Few clinical trials have examined cognitive behavioral therapy (CBT) interventions embedded in primary care settings to improve chronic pain among those receiving long-term opioid therapy. OBJECTIVE: To determine the effectiveness of a group-based CBT intervention for chronic pain. DESIGN: Pragmatic, cluster randomized controlled trial. (ClinicalTrials.gov: NCT02113592). SETTING: Kaiser Permanente health care systems in Georgia, Hawaii, and the Northwest. PARTICIPANTS: Adults (aged ≥18 years) with mixed chronic pain conditions receiving long-term opioid therapy. INTERVENTION: A CBT intervention teaching pain self-management skills in 12 weekly, 90-minute groups delivered by an interdisciplinary team (behaviorist, nurse, physical therapist, and pharmacist) versus usual care. MEASUREMENTS: Self-reported pain impact (primary outcome, as measured by the PEGS scale [pain intensity and interference with enjoyment of life, general activity, and sleep]) was assessed quarterly over 12 months. Pain-related disability, satisfaction with care, and opioid and benzodiazepine use based on electronic health care data were secondary outcomes. RESULTS: A total of 850 patients participated, representing 106 clusters of primary care providers (mean age, 60.3 years; 67.4% women); 816 (96.0%) completed follow-up assessments. Intervention patients sustained larger reductions on all self-reported outcomes from baseline to 12-month follow-up; the change in PEGS score was -0.434 point (95% CI, -0.690 to -0.178 point) for pain impact, and the change in pain-related disability was -0.060 point (CI, -0.084 to -0.035 point). At 6 months, intervention patients reported higher satisfaction with primary care (difference, 0.230 point [CI, 0.053 to 0.406 point]) and pain services (difference, 0.336 point [CI, 0.129 to 0.543 point]). Benzodiazepine use decreased more in the intervention group (absolute risk difference, -0.055 [CI, -0.099 to -0.011]), but opioid use did not differ significantly between groups. LIMITATION: The inclusion of only patients with insurance in large integrated health care systems limited generalizability, and the clinical effect of change in scores is unclear. CONCLUSION: Primary care-based CBT, using frontline clinicians, produced modest but sustained reductions in measures of pain and pain-related disability compared with usual care but did not reduce use of opioid medication. PRIMARY FUNDING SOURCE: National Institutes of Health.
PP - United States
PY - 2022
SN - 1539-3704; 0003-4819
SP - 46
EP - 55
EP - 
T1 - A Primary Care-Based Cognitive Behavioral Therapy Intervention for Long-Term Opioid Users With Chronic Pain : A Randomized Pragmatic Trial
T2 - Annals of Internal Medicine
TI - A Primary Care-Based Cognitive Behavioral Therapy Intervention for Long-Term Opioid Users With Chronic Pain : A Randomized Pragmatic Trial
U1 - Education & Workforce; Healthcare Disparities; Measures; Opioids & Substance Use
U2 - 34724405
U3 - 10.7326/M21-1436
VL - 175
VO - 1539-3704; 0003-4819
Y1 - 2022
Y2 - Jan
ER -