Pain Control Interactive Voice Response Study
This research study explored Interactive Voice Response (IVR) technology as an alternative method for management of chronic pain that relies less on pharmacological analgesia.
Chronic pain is a common and seriously debilitating condition both physically and psychologically. There is considerable evidence that a course of 8-12 weekly behaviorally-oriented group therapy sessions (Cognitive Behavioral Therapy) offers significant therapeutic benefit to patients with chronic pain. However, maintenance of coping skills after the groups have finished is variable and patients may experience decline in therapeutic benefit within a few weeks, which often leads to increase in pain medication use.
We have developed a telephone-based tool called Therapeutic Interactive Voice Response (TIVR) to maintain the use of pain coping skills taught at cognitive behavioral group therapy (CBT). Pilot tests of this tool found that patients who used the TIVR regularly not only maintained, but actually strengthened the therapeutic gains of CBT.
The primary goal of this study is to test whether TIVR enhances the therapeutic effect of group CBT for treatment of chronic pain and possibly decrease the use of medication for pain control. The long term objective is to create a tool that patients with chronic pain can use by telephone to review CBT skills independent of group therapy. Hopefully this will be a low-cost therapeutic intervention accessed by pain patients remotely.
The TIVR maintenance enhancement has four components:
Daily Self Monitoring Questionnaire This is a 21-item questionnaire that the patient completes each day for measures of daily coping, daily perceived pain control, and daily mood. It also includes items asking about medication use and stress. This part of the call takes approximately three minutes to complete. The remaining therapeutic interactive voice response (TIVR) components are optional and patients use them at will, as frequently or infrequently as they like. This component is designed to improve self-monitoring of pain behavior, use of coping skills, and use of medication.
Review of Skills Participants are able access a verbal review of eight different pain management skills they learned during the 11 weeks of cognitive behavioral group therapy (relaxation response, diaphragmatic breathing, positive self-talk, cognitive restructuring, activity-rest pacing, distraction techniques, reappraisal of pain, and defusing catastrophizing). Each review is approximately 5 minutes in length. The review messages are recorded in the voice of an experienced therapist with a soothing telephone voice.
Guided Rehearsal of Pain Coping Skills (Practice Sessions) Patients can access guided rehearsals of eight of the coping skills taught during CBT (body scan relaxation, diaphragmatic breathing, visualization, autogenic training, brief relaxation techniques ("minis"), cognitive restructuring, and sleep induction). For example, a patient who is feeling very tense or cannot fall asleep can call the TIVR to access a 10-minute relaxation message.
Monthly Therapist Feedback Message Once a month, Dr. Naylor analyzes computer-collated patient-specific data and records a personalized message for each participant onto the TIVR. These messages contain a summary of that person's daily reports to the TIVR for the past month; insight into possible relationships between use of coping skills, mood, stress and pain levels based on these daily data; suggestions for other pain management tactics; and verbal encouragement. Patients find these personalized monthly messages to be both valuable feedback and a continuing positive connection with the therapist. They also recognize that the value of the messages increases with the frequency of their own use of the TIVR, especially the Daily Questionnaire. Therefore, an important effect of the Monthly Message is to increase self-monitoring and adherence to pain management skills, and to improve overall motivation to remain engaged in the TIVR.