Cited by 101Musculoskeletal pain and rehabilitationDigital Mental Health InterventionsTelemedicine and Telehealth Implementation

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Interactive Voice Response–Based Self-management for Chronic Back Pain: The COPES Noninferiority Randomized Trial

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Heapy, Alicia A., Higgins, Diana M., Goulet, Joseph L., LaChappelle, Kathryn M., Driscoll, Mary A., Czlapinski, Rebecca A., Buta, Eugenia, Piette, John D., Krein, Sarah L., Kerns, Robert D.·2017·JAMA Internal Medicine

DOI 10.1001/jamainternmed.2017.0223PMC PMC5818820

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Abstract

Importance: Recommendations for chronic pain treatment emphasize multimodal approaches, including nonpharmacologic interventions to enhance self-management. Cognitive behavioral therapy (CBT) is an evidence-based treatment that facilitates management of chronic pain and improves outcomes, but access barriers persist. Cognitive behavioral therapy delivery assisted by health technology can obviate the need for in-person visits, but the effectiveness of this alternative to standard therapy is unknown. The Cooperative Pain Education and Self-management (COPES) trial was a randomized, noninferiority trial comparing IVR-CBT to in-person CBT for patients with chronic back pain. Objective: To assess the efficacy of interactive voice response-based CBT (IVR-CBT) relative to in-person CBT for chronic back pain. Design, Setting, and Participants: We conducted a noninferiority randomized trial in 1 Department of Veterans Affairs (VA) health care system. A total of 125 patients with chronic back pain were equally allocated to IVR-CBT (n = 62) or in-person CBT (n = 63). Interventions: Patients treated with IVR-CBT received a self-help manual and weekly prerecorded therapist feedback based on their IVR-reported activity, coping skill practice, and pain outcomes. In-person CBT included weekly, individual CBT sessions with a therapist. Participants in both conditions received IVR monitoring of pain, sleep, activity levels, and pain coping skill practice during treatment. Main Outcomes and Measures: The primary outcome was change from baseline to 3 months in unblinded patient report of average pain intensity measured by the Numeric Rating Scale (NRS). Secondary outcomes included changes in pain-related interference, physical and emotional functioning, sleep quality, and quality of life at 3, 6, and 9 months. We also examined treatment retention. Results: Of the 125 patients (97 men, 28 women; mean [SD] age, 57.9 [11.6] years), the adjusted average reduction in NRS with IVR-CBT (-0.77) was similar to in-person CBT (-0.84), with the 95% CI for the difference between groups (-0.67 to 0.80) falling below the prespecified noninferiority margin of 1 indicating IVR-CBT is noninferior. Fifty-four patients randomized to IVR-CBT and 50 randomized to in-person CBT were included in the analysis of the primary outcome. Statistically significant improvements in physical functioning, sleep quality, and physical quality of life at 3 months relative to baseline occurred in both treatments, with no advantage for either treatment. Treatment dropout was lower in IVR-CBT with patients completing on average 2.3 (95% CI, 1.0-3.6) more sessions. Conclusions and Relevance: IVR-CBT is a low-burden alternative that can increase access to CBT for chronic pain and shows promise as a nonpharmacologic treatment option for chronic pain, with outcomes that are not inferior to in-person CBT. Trial Registration: clinicaltrials.gov Identifier: NCT01025752.

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Authors: Heapy, A. A., Higgins, D. M., Goulet, J. L., LaChappelle, K. M., Driscoll, M. A., Czlapinski, R. A., Buta, E., Piette, J. D., Krein, S. L., & Kerns, R. D.
Affiliations: Yale University (US)
Boston University (US)
VA Connecticut Healthcare System (US)
University of Michigan (US)
Corresponding author: Heapy, Alicia A.
ORCID: Heapy, Alicia A.
Higgins, Diana M.
Goulet, Joseph L.
Driscoll, Mary A.
Buta, Eugenia
Piette, John D.
Krein, Sarah L.
Kerns, Robert D.
Venue: JAMA Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2017-06-01
Volume: 177
Issue: 6
Pages: 765
ISSN: 2168-6106 (ISSN-L)
DOI: 10.1001/jamainternmed.2017.0223
PMC: PMC5818820
OpenAlex: W2604772958
Cited by: 101
References: 46
Citations by year: 2026: 7 · 2025: 12 · 2024: 13 · 2023: 13 · 2022: 16 · 2021: 13 · 2020: 7 · 2019: 12 · 2018: 5 · 2017: 3
FWCI: 5.16
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA Internal Medicine (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Health Services Research and Development (#CIN 13-407)
National Institutes of Health (UL1TR001863)
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords: chronic back pain, interactive voice response, cognitive behavioral therapy, telemedicine, self-management, non-inferiority, pain intensity, sleep quality, physical function, quality of life, veterans, treatment retention, access to mental health care, Veterans Affairs health care, non-pharmacological pain management
MeSH terms: Simulation Training, Aged, Female, Humans, Male, Middle Aged, Patient Education as Topic, Self Care, Cognitive Behavioral Therapy, Low Back Pain, Telemedicine, Chronic Pain, Pain Management, Early Medical Intervention

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Interactive Voice Response–Based Self-management for Chronic Back Pain: The COPES Noninferiority Randomized Trial

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