‘Empowered Relief’ Approach Could Help Patients with Limited Time, Resources

By Jonathan Springston, Editor, Relias Media

One pain management skills class lasting two hours could be just as beneficial as eight sessions of cognitive behavioral therapy (CBT) for managing chronic low back pain (CLBP), according to the results of a recent study.

Researchers recruited 263 adults (131 women, 130 men, and two listed as “other”; mean age, 47.9 years) at a single center in San Francisco who reported experiencing CLBP for at least six months with a pain intensity of at least 4 on a scale between 0 and 10, with 10 representing worst pain. Investigators randomized participants into three groups: “empowered relief” (a single two-hour pain relief skill-building class to teach information about pain, mindfulness principles, and skills like self-soothing, relaxation, and cognitive reframing; n = 87), health education (a single two-hour class about back health, designed to match the empowered relief session in length, site, format, and structure; n = 88), or an eight-session CBT course (two hours per session, teaching information about CBT and pain management education; n = 88).

“CBT delivered in groups can offer important elements like contact with a therapist and peer support,” Helene Langevin, MD, lead author and director of the National Center for Complementary and Integrative Health, said in a statement. “But we realize that 16 hours of treatment time and the associated costs could be out of reach for some patients.”

Langevin and colleagues focused on changes in Pain Catastrophizing Scale scores after three months. This scale is a tool researchers use to measure 13 emotional and cognitive responses to pain. The authors of this study defined pain catastrophizing as “a cognitive and emotional pain response pattern that includes increased attention and feelings of pain helplessness.”

“Pain catastrophizing is associated with CLBP onset and treatment response, and decreased pain catastrophizing mediates the effects of CBT,” Langevin and colleagues wrote. “Mechanisms of pain catastrophizing include amplified distress and pain-facilitating neural patterns. Decreased pain catastrophizing favorably alters brain function and structure and appears to contribute to improved disability and activation.”

Investigators found similar improvements in Pain Catastrophizing Scale scores among those in CBT and those in empowered relief, with both groups well ahead of those in the health education group. (Empowered relief: -9.12; 95% confidence interval, -11.6 to -6.67; P < 0.001. CBT: -10.94; 95% confidence interval, -13.6 to -8.32; P < 0.001. Health education: -4.60; 95% confidence interval, -7.18 to -2.01; P < 0.001.)

“We underscore that empowered relief is not meant to replace the longer-course CBT, which offers extended therapist contact, peer support, and didactic content,” the authors stressed. “Rather, a range of behavioral treatment options is needed to meet the diverse needs and wants of patients. Empowered relief may improve patient access and engagement because it is adaptable to medical or community settings and may be offered at low or no cost. Empowered relief is suitable to online delivery, although efficacy may vary.”

For more on this study and other related subjects, keep an eye out for future issues of Integrative Medicine Alert and Hospital Case Management.