Multimodal approaches, including nonpharmacologic interventions, are often highlighted as essential treatment strategies for chronic back pain. Cognitive behavioral therapy (CBT) is a short-term, evidence-based treatment that takes a practical approach to manage & improve chronic pain. However, there are some access barriers. CBT is delivered by advanced health technology which naturally prevents the requirement of in-person visits, although the efficacy of this therapy to the conventional therapy is not known.

To cater this area of significant unmet need, The Cooperative Pain Education and Self-management (COPES) trial was conducted. The trial was a randomized, non-inferiority trial that compared the efficacy of interactive voice response–based CBT (IVR-CBT) to in-person CBT for chronic back pain patients. A total of 125 chronic pain patients were included, out of which 62 patients received IVR-CBT and 63 received in-person CBT.

Patients in IVR-CBT group were given a self-help manual and weekly prerecorded therapist feedback based on their IVR-reported activity, coping skill practice, and pain outcomes. Patients in in-person CBT group received weekly, individual CBT sessions with a therapist. Patients in both the groups obtained IVR monitoring of pain, sleep, activity levels, and pain coping skill practice. The primary endpoint of the trial was the change from baseline to 3 months in the patient report of average pain intensity measured by numeric rating scale (NRS). The secondary endpoints involved were changes in sleep quality, pain-related interference, physical and emotional functioning and QoL at three, six, and nine months. The researchers also investigated treatment retention.

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 under the predesignated non-inferiority margin of 1 showing IVR-CBT is not inferior. There were considerable improvements in physical functioning, sleep quality, and physical quality of life at three months as compared to baseline in both the groups, with no advantage for either treatment.

The results from the above study are sufficient to confirm that IVR-CBT is a useful and low-burden option that can improve access to CBT for chronic pain. It is an emerging nonpharmacologic treatment alternative for chronic pain, with similar results than in-person CBT.