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Publication Briefs

Study Assesses Self-Management Intervention for Chronic Pain

Chronic pain affects more adults in the U.S. than diabetes, heart disease, and cancer combined – and is associated with limitations in physical and emotional functioning, as well as quality of life. Cognitive behavioral therapy (CBT) is a low-risk psychological intervention that is effective in reducing pain and improving function for numerous pain complaints. Interactive voice response (IVR) – automated telephonic technology that allows patients to report symptoms, functioning, and pain coping skill use and to receive pre-recorded information and feedback – may improve access to CBT for chronic pain. This randomized trial assessed the efficacy of interactive voice response-based CBT (IVR-CBT) as compared to in-person CBT among 125 Veterans who received treatment for chronic back pain in the VA Connecticut Healthcare System from June 2012 through July 2015. IVR-CBT patients (n=62) received a self-help manual and weekly pre-recorded therapist feedback based on their IVR-reported activity, coping skill practice, and pain outcomes. In-person CBT patients (n=63) received weekly, individual CBT sessions with a therapist. Veterans in both groups received IVR monitoring of pain, sleep, activity levels, and pain coping skill practice during treatment. The primary outcome was change from baseline to 3 months in average pain intensity using a numeric rating scale (0=no pain, 10=worst pain imaginable). Secondary outcomes included changes in physical and emotional functioning, sleep, quality of life, adverse events, and treatment retention at 3, 6, and 9 months.


  • Veterans in both the IVR-CBT and in-person CBT groups experienced statistically significant reductions in average pain intensity at 3 and 6 months post-baseline, but not at 9 months. Regarding secondary outcomes, Veterans in both groups experienced statistically significant improvements in physical functioning, sleep, and physical quality of life at 3 months relative to baseline, with no advantage for either group.
  • The treatment dropout rate was lower among Veterans in the IVR-CBT group, with patients completing an average 2.3 more sessions.
  • Forty-six Veterans experienced 92 related and unrelated adverse events (AE) (IVR-CBT=40; in-person CBT=52); all related AEs were minor with most related to increased pain from exercise.


  • IVR-CBT is a low-burden alternative that can increase access to CBT for patients with chronic pain; it also shows promise as a non-pharmacologic treatment option for chronic pain, with outcomes that are not inferior to in-person CBT.


  • Because a third placebo arm was not included, investigators could not definitively show that either treatment is non-inferior to placebo.
  • Veterans in this study were slightly older and had longer pain duration than participants enrolled in trials to establish the efficacy of CBT.

This study was funded by HSR&D (IIR 09-058). Drs. Heapy and Goulet are part of HSR&D's Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center in West Haven, CT. Dr. Heapy is also with the Quality Enhancement Research Initiative (QUERI) Improving Pain-Related Outcomes for Veterans program.

PubMed Logo Heapy A, Higgins D, Goulet J, et al. Interactive Voice Response-Based Self-management for Chronic Back Pain: The COPES Noninferiority Randomized Trial. JAMA Internal Medicine. April 3, 2017; Epub ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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