McGuire Alan, Flanagan Mindy, Stout Madison E, Coffing Jessica, Kukla Marina, Traylor Morgan, Myers Laura, Henry Nancy, Carter Jessica, Matthias Marianne
VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana, USA.
Department of Psychology, Indiana University Purdue University, Indianapolis, Indiana, USA.
Health Serv Res. 2025 Aug;60(4):e14604. doi: 10.1111/1475-6773.14604. Epub 2025 Apr 10.
To examine the use of CBT-CP (Cognitive-behavioral therapy for chronic pain) by CBT-CP-trained therapists to treat patients with pain over a five-year period (October 2015-February 2020).
CBT-CP is a core evidence-based practice that is central to multidisciplinary chronic pain care. However, research suggests that CBT-CP is underused. The current study used national Veterans Health Administration data to examine the use of CBT-CP by CBT-CP-trained therapists to treat patients with pain over a five-year period.
Multilevel modeling was used to evaluate clinic, therapist, and patient-level factors as predictors of CBT-CP receipt.
Administrative data on 37,514 patients seen at a national sample of Veterans Health Administration locations for pain were collected from the U.S. Veterans Health Administration central data repository.
Results indicated 38.4% of patients with pain seen by a CBT-CP-trained therapist received CBT-CP during the observation period. Patients were more likely to receive CBT-CP if more time elapsed since their therapist received CBT-CP training and if their therapist had a master's degree (vs. a doctorate). Patients with somatic symptom disorder and depressive disorders were more likely to receive CBT-CP, while patients with comorbid personality disorders or substance use disorders were less likely to receive CBT-CP. Patients seen in pain specialty, PTSD, biomedical, and mental health clinics were more likely to receive CBT-CP than those not seen in these clinics.
Findings suggest that the reach of CBT-CP is substantively related to factors at each level. Future research is needed to better understand the therapy treatment decision-making processes and to address education gaps and other factors that impede the implementation of evidence-based practices.
研究接受过认知行为疗法治疗慢性疼痛（CBT-CP）培训的治疗师在五年期间（2015年10月至2020年2月）对疼痛患者使用CBT-CP的情况。
CBT-CP是一种核心的循证实践，是多学科慢性疼痛护理的核心。然而，研究表明CBT-CP的使用不足。本研究使用美国退伍军人健康管理局的全国数据，考察接受过CBT-CP培训的治疗师在五年期间对疼痛患者使用CBT-CP的情况。
采用多层次模型评估诊所、治疗师和患者层面的因素，作为接受CBT-CP治疗的预测指标。
从美国退伍军人健康管理局中央数据存储库收集了在全国退伍军人健康管理局地点因疼痛就诊的37514名患者的管理数据。
结果表明，在观察期内，接受过CBT-CP培训的治疗师接诊的疼痛患者中有38.4%接受了CBT-CP治疗。如果治疗师接受CBT-CP培训的时间越长，以及治疗师拥有硕士学位（相对于博士学位），患者就越有可能接受CBT-CP治疗。患有躯体症状障碍和抑郁症的患者更有可能接受CBT-CP治疗，而患有共病性人格障碍或物质使用障碍的患者接受CBT-CP治疗的可能性较小。在疼痛专科、创伤后应激障碍、生物医学和心理健康诊所就诊的患者比未在这些诊所就诊的患者更有可能接受CBT-CP治疗。
研究结果表明，CBT-CP的覆盖范围与每个层面的因素密切相关。未来需要开展更多研究，以更好地理解治疗决策过程，并解决教育差距和其他阻碍循证实践实施的因素。
