Health Behavior Research Center

Pain Control Interactive Voice Response Study

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.

Phone Script

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.