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Randomized Controlled Trial of Telephone-Delivered Cognitive Behavioral Therapy versus Supportive Care for Chronic Back Pain

Rutledge Thomas PhD; Atkinson, J. Hampton MD; Chircop-Rollick, Tatiana PhD; D’Andrea, John; Garfin, Steven MD; Patel, Shetal PsyD; Penzien, Donald B. PhD; Wallace, Mark MD; Weickgenant, Anne L. PhD; Slater, Mark PhD
The Clinical Journal of Pain: Post Acceptance: September 01, 2017
doi: 10.1097/AJP.0000000000000555
Original Article: PDF Only

Objective:

To evaluate the efficacy of a telephone-delivered, home-based cognitive behavioral intervention for chronic low back pain in comparison to a matched supportive care treatment.

Methods:

Participants (N=66) were patients with chronic back pain that were randomized to either an 8-week Cognitive-Behavioral Therapy (CBT) or a Supportive Care condition (SC) matched for contact frequency, format, and time. Participants completed validated measures of improvement in back pain disability, pain severity, and overall improvement.

Results:

Intent-to-treat analyses at post-treatment showed that the treatment groups showed non-significantly different improvements in back pain disability (mean changes=−2.4 & −2.6 for CBT & SC, respectively; Cohen’s d’s=0.49 & 0.55, respectively) and reductions in pain severity (mean changes=−0.9 & −1.4 for CBT & SC respectively; Cohen’s d’s=0.50, & 0.90, respectively). Participants rated their overall improvement levels at 31% (CBT) versus 18.5% (SC).

Discussion:

Results from this clinical trial suggest that home-based, telephone-delivered CBT and SC treatments did not significantly differ in their benefits for back pain severity and disability, and may warrant further research for applications to hospital settings. Major limitations included recruitment difficulties that underpowered primary analyses, the lack of objectives improvement measures, and the absence of a usual care/untreated control group for comparisons.

Trial Registry: ClinicalTrials.gov NCT00608530.

This research was supported by the Office of Research and Development, Rehabilitation Research and Development Service, Department of Veterans Affairs. The funding source had no role in data analysis or development of this manuscript.

Acknowledgments Author declaration: All listed authors had full access to the data for this manuscript and contributed directly to the development of the manuscript through writing, editorial review, and statistical analyses. The corresponding author had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Rutledge and Dr. Slater conducted all study analyses and assembled the tables and figures for the manuscript.

This research was supported by the Office of Research and Development, Rehabilitation Research and Development Service, Department of Veterans Affairs. The funding organization was not involved in the (1) design and conduct of the study; (2) collection, management, analysis, and interpretation of the data; (3) preparation, review, or approval of the manuscript; or (4) decision to submit the manuscript for publication.

Conflict of interest statement: All authors declared no study-related conflicts of interest in the development of this manuscript.

Reprints: Thomas Rutledge, PhD, ABPP, Psychology Service 116B, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161 (e-mail: Thomas.Rutledge@va.gov).

Received November 8, 2016

Accepted July 6, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.