VA Center for Integrated Healthcare, VA Western New York Healthcare System.
School of Public Health and Health Professions.
Clin J Pain. 2019 Oct;35(10):809-817. doi: 10.1097/AJP.0000000000000747.
Although cognitive behavioral therapy is an effective intervention for chronic pain, it is a lengthy treatment typically applied only in specialty care settings. The aim of this project was to collect preliminary effectiveness data for Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP), an abbreviated, modular form of treatment designed for use in primary care.
A clinical demonstration project was conducted in which Brief CBT-CP was delivered to primary care patients by 22 integrated care providers practicing in the Primary Care Behavioral Health model of Veterans Health Administration primary care clinics. Brief measures were used at each appointment to collect patient-reported clinical outcomes.
One hundred eighteen patients provided sufficient data for analysis (male, 75%; mean age, 51.4 y). Multilevel modeling suggested that a composite measure of pain intensity and functional limitations showed statistically significant improvements by the third appointment (Cohen's d=0.65). Pain-related self-efficacy outcomes showed a similar pattern of results but of smaller effect size (Cohen's d=0.22). The exploratory analysis identified that Brief CBT-CP modules addressing psychoeducation and goal setting, pacing, and relaxation training were associated with the most significant gains in treatment outcomes.
These findings provide early support for the effectiveness of Brief CBT-CP when delivered by providers in every day Primary Care Behavioral Health settings. Results are discussed in relation to the need for additional research regarding the potential value of employing safe, population-based, nonpharmacological approaches to pain management in primary care.
认知行为疗法是一种治疗慢性疼痛的有效方法，但治疗时间较长，通常仅在专业医疗环境中实施。本项目旨在收集针对慢性疼痛的简明认知行为疗法（Brief CBT-CP）的初步疗效数据，这是一种经过简化的、模块化的治疗方法，旨在用于初级保健。
开展了一项临床示范项目，由 22 名在退伍军人事务部初级保健诊所的初级保健行为健康模式下执业的综合医疗服务提供者为初级保健患者提供 Brief CBT-CP。在每次预约时，使用简短的措施收集患者报告的临床结果。
118 名患者提供了足够的数据进行分析（男性占 75%；平均年龄为 51.4 岁）。多层次模型表明，疼痛强度和功能障碍的综合衡量指标在第三次预约时显示出统计学上的显著改善（Cohen's d=0.65）。与疼痛相关的自我效能结果呈现出类似的结果模式，但效果较小（Cohen's d=0.22）。探索性分析表明，针对心理教育和目标设定、节奏控制和放松训练的 Brief CBT-CP 模块与治疗结果的最大改善相关。
这些发现为初级保健行为健康环境中由医疗服务提供者提供的 Brief CBT-CP 的有效性提供了早期支持。结果与需要进一步研究安全、基于人群的非药物方法在初级保健中管理疼痛的潜在价值有关。
