Remote CBT for Chronic Pain Shows Modest but Lasting Benefits

New research showed remote, scalable cognitive behavioral therapy (CBT) for chronic pain brought moderate improvements in pain and related functional or quality-of-life outcomes.

“Findings suggest that centralizing delivery of the CBT-CP-based programs via telephone/videoconferencing and online interventions is effective, with potential for widespread dissemination into clinical care and health care organizations nationwide,” wrote investigators, led by Lynn L. DeBar, PhD, MPH, from Kaiser Permanente Center for Health Research, in Portland, Oregon.

Patients can turn to many nonpharmacologic options to manage chronic pain—exercise, nutrition, mind-body techniques, acupuncture, or spinal manipulation. CBT interventions are the first-line nonpharmacologic option for chronic pain, but they are not easily accessible; urban areas may have limited CBT-trained clinicians. With virtual CBT options, this could be a way for patients with chronic pain to get relief.

Investigators sought to examine the effectiveness of remote, scalable CBT-based chronic patient treatments compared with usual care in the phase 3 randomized RESOLVE trial. The study included 2331 patients aged ≥ 18 years with high-impact chronic musculoskeletal pain from 4 US health care systems: Kaiser Permanente Georgia (northern Georgia), Kaiser Permanente Northwest (Oregon and southwest Washington), Kaiser Permanente Washington (Washington and Idaho), and Essentia Health (northern Minnesota, eastern North Dakota, and northern Wisconsin). Participants were included if they had at least 1 or 2 outpatient visits more than 60 days apart for nonmalignant musculoskeletal pain within the past 360 days, if they had high-impact chronic pain determined by the Graded Chronic Pain Scale-Revised, and a 12 or higher on the Pain, Enjoyment of Life, and General Activity scale.

Participants were randomized 1:1:1 to receive either:

· 8 CBT sessions led by a health coach via telephone or videoconferencing (n = 778)

· 8 CBT sessions via online self-completed program (painTRAINER) (n= 776)

· Usual care plus a resource guide (n = 777).

The study took place between January 2021 and February 2023. Follow-up finished in April 2024. The primary outcome was meeting or exceeding the minimal clinically important difference (MCID) in pain severity score (≥ 30% decrease; score range, 0 – 10) on the 11-item Brief Pain Inventory-Short Form from baseline to 3 months. Secondary time points were 6 and 12 months from baseline.

Other secondary outcomes, measured at 3, 6, and 12 months, included pain intensity, pain-related interference, Patient-Reported Outcomes Measurement Information System (PROMIS), social role and physical functioning, and patient global impression of change.

The sample had a mean age of 58.8 years, 74% women, and 44% rural or medically underserved. The majority completed the trial (94.8%).

At 3 months, the adjusted percentage of participants achieving ≥ 30% in the pain severity score was 32.0 (95% confidence interval [CI], 29.3 – 35.0) in the health coach group, 26.6 (95% CI, 23.4 – 30.1) in the painTRAINER group, and 20.8 (95% CI, 18.0 – 24.0) in the usual care group. The health coach and painTRAINER groups were significantly more likely to achieve an MCID in pain severity compared to controls (relative risk [RR], 1.54; 95% CI, 1.30 – 1.82 and RR, 1.28; 95% CI, 1.06 – 1.55, respectively).

Ultimately, the health coach program was more effective than the painTRAINER (RR, 95% CI, 1.03 – 1.40) at 3 months. However, compared with usual care, both interventions brought statistically significant benefits

“The modest benefit of active CBT-based interventions over usual care was sustained during longer-term follow-up (6 and 12 months), with no relative benefit observed for the health coach group compared with the painTRAINER group at these later points,” investigators wrote.

References

1. DeBar LL, Mayhew M, Wellman RD, et al. Telehealth and Online Cognitive Behavioral Therapy-Based Treatments for High-Impact Chronic Pain: A Randomized Clinical Trial. JAMA. Published online July 23, 2025. doi:10.1001/jama.2025.11178

2. Non-Drug Approaches to Chronic Pain. https://www.va.gov/WHOLEHEALTHLIBRARY/tools/non-drug-approaches-to-chronic-pain.asp. Accessed July 24, 2025.