Outcomes of a 6-week Cognitive-Behavioral Therapy for Chronic Pain Group for veterans seen in primary care

Abstract

Primary Care Mental Health Integration (PC-MHI) visits are mandated to be brief, limited in number, and delivered in the primary care practice area. Current evidence-based protocols for Cognitive-Behavioral Therapy for Chronic Pain (CBT-CP) do not meet these PC-MHI requirements, however, and thus PC-MHI providers are often left with the daunting task of modifying these protocols for the primary care setting. The aims of the current study were to examine effectiveness for a brief CBT-CP Group (6, 50-min sessions) for patients seen in primary care with various chronic pain conditions and to assess whether opioid medication use was associated with treatment outcomes. The current study represents a single-arm treatment study in which outcomes were evaluated by comparing self-reported symptom levels at the beginning of treatment (Session 1) to the end of treatment (Session 6). Dependent variables included pain symptoms, physical function lower/upper body, family disability, emotional functioning, sleep problems, satisfactions with outcomes/care, pain-related anxiety, generalized anxiety, pain catastrophizing, and depressed mood. Seventy-seven participants were enrolled and completed the treatment group. They were 56.81 ± 13.11 years old, 61% male, 51.9% taking opioids, with 39% reporting multiple pain diagnoses. Results showed that participation in the Brief CBT-CP Group resulted in statistically significantly improvement across all dependent variables (except emotional functioning). Results also showed that there were no significant treatment-related differences between patients taking opioids compared with patients who were not on opioids. The current protocol for Brief CBT-CP is effective in a real-world setting and aligns with the PC-MHI model of care.