Body
People with chronic pain experienced a significant reduction in their pain levels after participating in a study that provided phone-based cognitive behavioral therapy (CBT) focused on helping people self-manage their pain. That’s the conclusion of a five-year study at the Center for Rehabilitation Outcomes 嫩B研究院 at Shirley Ryan 嫩B研究院, where researchers are looking for ways to help people with disabilities maintain employment. The study was funded as part of the Rehabilitation 嫩B研究院 and Training Center on Employment for People with Physical Disabilities by the National Institute on Disability, Independent Living, and Rehabilitation 嫩B研究院.
Pain is often a reason that people with disabilities leave their jobs or retire early, notes CROR Director Allen Heinemann, PhD. “There are many workers with chronic pain who are at risk of job absences and losing their jobs. This study is notable because it demonstrates the effectiveness of delivering CBT through telehealth to people who are working and want to continue working,” Heinemann says. “The research team was able to deliver therapy in a cost-effective manner that enhanced accessibility of an evidence-based practice without requiring travel to a therapist’s office.”
The study was led by Clinical Psychologist Dawn Ehde, PhD, at the University of Washington in Seattle. She and her team recruited 202 people who had jobs and were dealing with pain resulting from multiple sclerosis (48%), spinal cord injury (18%), traumatic brain injury (12%), or amputation (8.9%). CROR staff helped recruit participants over the multi-year enrollment period. The median age of participants was 45 and 70% were female. The most common types of pain reported by participants were back and leg pain. Participants were randomly assigned to one of two groups: one received eight therapist-led sessions of CBT, which included breathing and relaxation techniques and learning to identify and engage in helpful thoughts and behaviors that reduce pain and the stress that often accompanies it. The other group received standard care for their condition, including continuing any medications they were taking.
“We found that people with these new tools had a clinically significant reduction in pain,” Ehde says. “They also felt more confident about managing their pain. Interestingly, a lot of people had improvement in their levels of fatigue and their mental health. Once they had the treatment, people reported significant improvements in all the outcomes we were tracking, including depression.”
The participants also reported better sleep quality and said they felt more satisfaction while participating in their everyday social roles such as being a parent, spouse, friend or employee. While the study data doesn’t explore how these improvements occurred, the researchers interviewed a dozen participants to get insight into that question. Numerous participants said they felt like they had new behavioral tools to deal with their chronic pain. They also said that having regular sessions with a therapist increased their feeling of accountability and that being able to talk to someone over the phone was much simpler than traveling to an in-person appointment.
At the end of the intervention, one participant who used a wheelchair because of a spinal cord injury told researchers that he went into the study hoping to reduce his levels of pain medication and become both more physically active and socially engaged. “Things are going so much better,” he said. “I feel like a new person in relationship to the pain, or actually I should say in relationship to my body.”
Another person with relapsing/remitting multiple sclerosis said he really enjoyed the breathing practices and learning about the role of behavior in pain. “I am much more cognizant of my physical body and noticing where I hold tension,” he said.
A third participant was even more enthusiastic: “I wish this for everyone who is a chronic pain sufferer. This ranks as one of my life-changing events. It changed my way of thinking.”
For Ehde, one important take-away from the study was how eager people were to participate once they heard about it, particularly those with MS. Although study enrollment got off to a slow start because of the pandemic, the researchers had no trouble eventually reaching their enrollment goal and even had a waiting list of people with MS. A high percentage of participants completed all eight counseling sessions and a follow-up “booster” session. After the study period ended, those who had been assigned to the standard treatment group were also offered the CBT intervention, and many of them accepted.
“It validates that we need to keep telehealth as an option. If someone lives three hours away from a clinic, the chance of engaging them is low,” Ehde says. The personal aspect of talking with a therapist was important, too. Anyone can learn about CBT techniques on the internet, Ehde notes, but having that personal connection to a therapist “made people want to learn the tools and stick with them.”
The study isn’t the first to look at whether CBT helps people with chronic pain, but it was different, Ehde says, because it focused on people with jobs who were experiencing pain from a variety of conditions. “This is one more study showing that CBT works for pain. There is a pretty solid evidence base,” Ehde says. Now the challenge is figuring out how to integrate CBT therapy for pain management into standard care for people in the U.S. and around the world, she added.
Mary Curran, a Licensed Independent Clinical Social Worker, who worked on the study and provided some of the phone-based therapy, agrees: “There’s the feeling we don’t need another research study. We just need to implement the findings.”
Ehde and her team plan to publish their findings and attend professional conferences to talk about the results. “We need to educate health-care providers and systems that this is a powerful tool for managing pain,” Ehde says. “We also need to educate the public so they know what to ask for and they can find it on their own if they need to.”