Cognitive behavioral therapy for chronic pain supported by digital patient feedback and artificial intelligence: Do patients with socioeconomic risk factors benefit?

Abstract

Background

In a recent comparative effectiveness trial, patients with chronic pain receiving cognitive behavioral therapy supported by artificial intelligence and digital feedback (AI-CBT-CP) were more likely to report clinically meaningful improvements in pain-related disability and intensity at six months than patients randomized to standard telephone CBT-CP. Concerns persist about the impact of AI and digital interventions among socially disadvantaged patients. We examined variation in the proportion of patients completing all treatment sessions and reporting clinically meaningful improvements in pain-related disability and intensity across subgroups of patients defined by social determinants of health (SDOH).

Methods

SDOH indicators included age, race, gender, education, income, marital status, geographic access, and clinical severity. Multivariate models with interaction terms tested SDOH indicators as potential moderators of treatment engagement and response to AI-CBT-CP versus standard telephone CBT-CP.

Findings

Roughly half of participants (52.9 %) were 65+ years of age, 10.8 % were women, and 19.1 % reported Black race or multiple racial identities. Relatively favorable session completion was observed among patients randomized to AI-CBT-CP across SDOH subgroup, with no groups more likely to complete all session weeks when receiving standard telephone CBT-CP. The relative benefits of AI-CBT-CP in terms of pain-related disability and intensity were generally confirmed across SDOH subgroups. AI-CBT-CP had a greater relative impact on pain-related disability among patients <65 years old (p = .002). In none of the SDOH subgroups, did standard telephone CBT-CP have a greater impact on pain-related disability or intensity than AI-CBT-CP.

Interpretation

These findings do not suggest that patients with SDOH disadvantages experience poorer treatment engagement or outcomes when offered CBT-CP supported by AI and digital feedback instead of standard telephone CBT-CP. AI-CBT-CP can help overcome treatment access barriers without exacerbating disparities, benefiting underserved populations with chronic pain.

Funding

US Department of Veterans Affairs Health Services Research and Development program.