April 3, 2017 / 7:56 PM / 6 months ago

Computerized phone therapy might help curb back pain

(Reuters Health) - - For some patients with chronic back pain, computerized phone therapy might work just as well at easing symptoms as in-person visits with a therapist, a small study suggests.

The experiment focused on what’s known as interactive voice response technology, which works something like the computerized prompts people can encounter when they call a bank or insurance company. In this case, the prompts focused on back pain issues and guided patients to advice on symptom relief.

Researchers randomly assigned 125 patients with chronic back pain to get ten weekly sessions of cognitive behavior therapy (CBT), either in person or over the phone using interactive voice response (IVR).

After three months, all of the patients experienced similar reductions in pain and improvements in things like physical functioning and sleep.

“Technology-based forms of CBT, like CBT delivered via automated calls that we used in the trial, can be more accessible and convenient for people with chronic pain, as well as equally effective,” said lead study author Alicia Heapy of the VA Connecticut Healthcare System in West Haven.

While previous studies have suggested computerized calls might work for back pain, the current study offers fresh evidence of its effectiveness relative to the current gold standard of in-person treatment with a therapist, Heapy said by email.

“Making this comparison provides evidence for recommending it as an alternative to in-person treatment for people who are not able to regularly travel for in-person CBT sessions or who live in an area where there are no clinicians trained to deliver CBT for chronic pain, or for those who might prefer this approach as a matter of convenience,” Heapy said.

Study participants were 58 years old on average and most of them were male. Half of them had been living with back pain for at least 11 years.

All of them were VA patients, and only about 21 percent of them lived less than ten miles from their local VA facility. About 35 percent of them lived between 10 and 25 miles away, and another 44 percent had to travel even longer distances from home.

At the start of the study, every participant received a manual explaining how cognitive behavior therapy can help with pain management and functioning in daily life even when pain persists. This approach focuses on helping people become more physically active, engage with activities they enjoy and pursue new things if those old activities aren’t possible.

Researchers asked participants to rate their average pain levels over the previous week on a scale from 0 for no pain up to 10 for the worst pain imaginable. People rated their pain as about a 5.6 on average at the start of the study, indicating moderate pain.

After treatment, both groups reported a similar average reduction in pain ratings of about 0.8, researchers report in JAMA Internal Medicine.

Beyond its small size, another limitation of the study is that researchers didn’t include a control group of people who received no therapy at all. More research is needed at additional locations and among different patient populations before drawing any broad conclusions about how well computerized therapy might work for back pain, the researchers also point out.

“It’s probably too early to recommend this to patients since it’s not widely available yet,” said Daniel Cherkin of the Kaiser Permanente Washington Health Research Institute in Seattle.

“However, these results suggest that other existing online CBT or other mind-oriented programs for chronic pain might be worth trying,” Cherkin, who wasn’t involved in the study, said by email.

Even if more research suggests it’s effective, computerized voice technology still might not work for every patient with back pain, said Dr. Jatin Joshi, a pain and spine care researcher at Weill Cornell School of Medicine in New York who wasn’t involved in the study.

“Although online treatment is appealing for its convenience, there are certain psychological and medical conditions that need direct supervised medical management,” Joshi said by email. “It’s important that patients receive any care, on-line or in-person, under the supervision of a trained medical professional.”

SOURCE: bit.ly/2oR7Ix6 JAMA Internal Medicine, online April 3, 2017.

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