VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut, USA.
Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.
Pain Med. 2023 Jul 5;24(7):846-854. doi: 10.1093/pm/pnac192.
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.
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).
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.
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.
慢性疼痛的认知行为疗法（CBT-CP）有很强的证据基础，但对于何时能获得治疗益处知之甚少。本研究是对招募参加一项比较交互式语音应答（IVR）CBT-CP 与面对面 CBT-CP 的非劣效性试验的慢性腰痛患者进行的二次分析。
根据每日 IVR 调查的数据，与基线周相比，疼痛强度降低 30%（n=108）或每日步数增加 45%（n=104）定义为有临床意义的变化。我们确定了在治疗过程中的任何时候都达到有意义变化的个体，然后将那些在最后治疗周保持有意义变化的个体（即应答者）与那些没有或虽有但恢复的个体（即无应答者）进行比较。
在治疗期间，46%的参与者疼痛强度有临床意义的降低，66%的参与者每天的步数有临床意义的增加。就疼痛强度的降低而言，共有 54%的患者被归类为应答者，就步数的增加而言，70%的患者为应答者。生存分析发现，50%的应答者在第 4 周首次达到疼痛强度的临床意义变化，在第 2 周首次达到每日步数的临床意义变化。脱落和人口统计学变量与应答者状态无关，两种治疗反应测量之间的一致性较低。
总的来说，结果表明大多数应答者在 4 周内有所改善。评估治疗反应高度依赖于结果测量，与结果之间的相关性较低。
