Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2023 Jul 5;24(7):846-854.
doi: 10.1093/pm/pnac192.

Using Daily Ratings to Examine Treatment Dose and Response in Cognitive Behavioral Therapy for Chronic Pain: A Secondary Analysis of the Co-Operative Pain Education and Self-Management Clinical Trial

R Ross MacLean  1   2 , Eugenia Buta  3 , Diana M Higgins  4   5 , Mary A Driscoll  1   2 , Sara N Edmond  1   2 , Kathryn M LaChappelle  1 , Brett Ankawi  1   2 , Sarah L Krein  6   7 , John D Piette  6   8 , Alicia A Heapy  1   2
Affiliations
Clinical Trial

Using Daily Ratings to Examine Treatment Dose and Response in Cognitive Behavioral Therapy for Chronic Pain: A Secondary Analysis of the Co-Operative Pain Education and Self-Management Clinical Trial

R Ross MacLean et al. Pain Med. .

Abstract

Background: Cognitive behavioral therapy for chronic pain (CBT-CP) has a strong evidence base, but little is known about when treatment benefits are achieved. The present study is a secondary analysis of individuals with chronic back pain recruited for a noninferiority trial comparing interactive voice response (IVR) CBT-CP with in-person CBT-CP.

Methods: On the basis of data from daily IVR surveys, a clinically meaningful change was defined as a 30% reduction in pain intensity (n = 108) or a 45% increase in daily steps (n = 104) compared with the baseline week. We identified individuals who achieved a meaningful change at any point during treatment, and then we compared those who maintained a meaningful change in their final treatment week (i.e., responders) with those who did not or who achieved a meaningful change but lapsed (i.e., nonresponders).

Results: During treatment, 46% of participants achieved a clinically meaningful decrease in pain intensity, and 66% achieved a clinically significant increase in number of steps per day. A total of 54% of patients were classified as responders in terms of decreases in pain intensity, and 70% were responders in terms of increases in step count. Survival analyses found that 50% of responders first achieved a clinically meaningful change by week 4 for pain intensity and week 2 for daily steps. Dropout and demographic variables were unrelated to responder status, and there was low agreement between the two measures of treatment response.

Conclusions: Collectively, results suggest that most responders improve within 4 weeks. Evaluating treatment response is highly specific to the outcome measure, with little correlation across outcomes.

Trial registration: ClinicalTrials.gov NCT01025752.

Keywords: Chronic Pain; Cognitive Behavioral Therapy; Dose; Interactive Voice Response; Pain Intensity.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: None of the authors have any conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Flow chart to define treatment responders for pain intensity and daily step count. Note: Clinically meaningful change for pain intensity was defined as a 30% reduction from baseline. Clinically meaningful change for step count was defined as a 45% increase from baseline. Individuals who obtained a clinically meaningful change at some point during treatment but who did not meet the above criteria at the last treatment week were categorized as “lapsed” and considered nonresponders.
Figure 2.
Figure 2.
Kaplan-Meier curves for each outcome by treatment week. Note: Shaded regions reflect the session at which at least 50%, 75%, and 95% of responders reported a clinically meaningful change.
Figure 3.
Figure 3.
Weekly average for each outcome by responder status. Note: Average of available data for each outcome at each treatment week. Bars represent standard error of mean.
See this image and copyright information in PMC

References

    1. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. Am Psychol 2014;69(2):153–66. - PubMed
    1. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol 2007;26(1):1–9. - PubMed
    1. Dixon KE, Keefe FJ, Scipio CD, Perri LM, Abernethy AP. Psychological interventions for arthritis pain management in adults: A meta-analysis. Health Psychol 2007;26(3):241–50. - PubMed
    1. Bernardy K, Klose P, Welsch P, Häuser W. Efficacy, acceptability and safety of Internet-delivered psychological therapies for fibromyalgia syndrome: A systematic review and meta-analysis of randomized controlled trials. Eur J Pain 2019;23(1):3–14. - PubMed
    1. Burns JW. Mechanisms, mechanisms, mechanisms: It really does all boil down to mechanisms. Pain 2016;157(1111):2393–4. - PMC - PubMed

Publication types

Associated data