Nationwide Implementation and Outcomes of Cognitive Behavioral Therapy for Chronic Pain Over Clinical Video Teleconferencing

Abstract

Use of telehealth technology to provide cognitive behavioral therapy for chronic pain (CBT-CP) is a promising practice given the prevalence of chronic pain and the difficulties in accessing CBT-CP. This paper is the first to describe the successful nationwide delivery of CBT-CP via clinical video teleconferencing (CVT) across a network of 37 sites in 14 states. Two hundred three patients with a variety of pain diagnoses were surveyed using the Pain Outcomes Questionnaire-VA (POQ) immediately before their initial CBT-CP CVT appointment and again at the final treatment appointment. Treatment consisted of an evidence-based CBT-CP protocol disseminated widely in the Veterans Health Administration (VHA) and delivered over 8–10 1-h individual therapy appointments. Paired sample t tests showed statistically significant improvements in pre-test to post-test scores for pain intensity, activities of daily living, vitality, and negative affect. Effect sizes were moderate, increasing confidence that these improvements were also clinically meaningful. Patients reported high levels of satisfaction on all five satisfaction items. This is the only study reporting results from CBT-CP services provided at such a large number of clinics over thousands of miles. While VHA is uniquely poised to deliver telehealth services across states due to its use of a reliable high-speed CVT network, nationwide electronic medical records system, absence of cross-state licensure restrictions, and capitated payment system; as the healthcare system in the USA moves toward nationwide electronic medical records and implementation of interstate licensing agreements, CVT would have increasing applicability outside of VHA.