Patient and provider perspectives of Brief Cognitive Behavioral Therapy for Chronic Pain: a qualitative analysis of a pilot randomized controlled trial.

Abstract

Objective: Brief non-pharmacologic chronic pain treatments are largely effective and widely recommended for pain self-management. The purpose of this study was to evaluate veteran and provider perceptions of acceptability, appropriateness, and feasibility of Brief Cognitive Behavioral Therapy (Brief CBT-CP) content and materials to inform future implementation efforts in primary care and other integrated settings.

Design: Qualitative analysis of data from a pilot randomized controlled trial (RCT).

Setting: Two Veterans Affairs (VA) primary care clinics in the Northeast.

Subjects: Veterans (n = 10) who completed Brief CBT-CP treatment, integrated behavioral health providers (IBHPs; n = 3 clinical social workers; n = 4 clinical psychologists), and primary care physicians (PCPs; n = 5).

Method: Rapid Qualitative Analysis of semi-structured interview data.

Intervention: Brief CBT-CP, an adapted intervention for chronic pain intended for use in primary care and other integrated care settings utilizing brief treatment modalities.

Results: PCPs and IBHPs described Brief CBT-CP as highly acceptable and clinically useful, particularly in response to its focus on biopsychosocial pain self-management skills. Similarly, veterans pointed to the non-pharmacologic skills as a highly acceptable component of treatment. The intervention was also viewed as highly appropriate by providers who emphasized the treatment's alignment with the tenets of primary care, accessibility, and potential to strengthen stepped care adherence. Some providers suggested minor modifications to the content. Veterans regarded Brief CBT-CP as highly appropriate due to the customizability of the non-pharmacologic skills which helped them achieve their recovery goals while acknowledging that the primary limitation was the intervention's inability to completely eliminate pain. Providers, who viewed the intervention as practical overall, anticipated issues such as patient readiness and logistics as potentially impacting treatment uptake; veterans, however, perceived the intervention as feasible, favoring flexibility with scheduling.

Conclusions: Veterans and providers endorsed Brief CBT-CP as a highly acceptable, highly appropriate, and generally feasible non-pharmacological behavioral pain treatment. Veterans described improvements across behavioral, cognitive, and affective domains including decreased pain levels, increased pain tolerance, improved functioning, and decreased stress related to pain.

Clinical trial information: The Clinical Trials Registration #NCT03490981.