Patient and provider perspectives of Brief Cognitive Behavioral Therapy for Chronic Pain: a qualitative analysis of a pilot randomized controlled trial.

OBJECTIVE: Brief non-pharmacologic chronic pain treatments are largely effective and widely recommended for pain self-management. The purpose of this study was to evaluate veteran and provider perceptions of acceptability, appropriateness, and feasibility of Brief Cognitive Behavioral Therapy (Brief CBT-CP) content and materials to inform future implementation efforts in primary care and other integrated settings. DESIGN: Qualitative analysis of data from a pilot randomized controlled trial (RCT). SETTING: Two Veterans Affairs (VA) primary care clinics in the Northeast. SUBJECTS: Veterans (n = 10) who completed Brief CBT-CP treatment, integrated behavioral health providers (IBHPs; n = 3 clinical social workers; n = 4 clinical psychologists), and primary care physicians (PCPs; n = 5). METHOD: Rapid Qualitative Analysis of semi-structured interview data. INTERVENTION: Brief CBT-CP, an adapted intervention for chronic pain intended for use in primary care and other integrated care settings utilizing brief treatment modalities. RESULTS: PCPs and IBHPs described Brief CBT-CP as highly acceptable and clinically useful, particularly in response to its focus on biopsychosocial pain self-management skills. Similarly, veterans pointed to the non-pharmacologic skills as a highly acceptable component of treatment. The intervention was also viewed as highly appropriate by providers who emphasized the treatment's alignment with the tenets of primary care, accessibility, and potential to strengthen stepped care adherence. Some providers suggested minor modifications to the content. Veterans regarded Brief CBT-CP as highly appropriate due to the customizability of the non-pharmacologic skills which helped them achieve their recovery goals while acknowledging that the primary limitation was the intervention's inability to completely eliminate pain. Providers, who viewed the intervention as practical overall, anticipated issues such as patient readiness and logistics as potentially impacting treatment uptake; veterans, however, perceived the intervention as feasible, favoring flexibility with scheduling. CONCLUSIONS: Veterans and providers endorsed Brief CBT-CP as a highly acceptable, highly appropriate, and generally feasible non-pharmacological behavioral pain treatment. Veterans described improvements across behavioral, cognitive, and affective domains including decreased pain levels, increased pain tolerance, improved functioning, and decreased stress related to pain. CLINICAL TRIAL INFORMATION: The Clinical Trials Registration #NCT03490981. Pain is often first treated in primary care. Despite many patients being interested in alternatives to pain medicine or strategies they can use while taking medicine, self-management practices are not routinely taught. Skills like taking breaks during tasks that increase pain, using special exercises to relax muscles, and changing how we think to avoid going to worst-case scenarios are proven to be helpful for those living with chronic pain. We wanted to know if veterans and providers would be receptive to a brief treatment for chronic pain, Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP), grounded in these evidence-based practices. This study is unique because we spoke not only with veterans who received the treatment, but also primary care doctors and mental health providers who would be recommending or delivering it. Veterans overwhelmingly found the treatment helpful because it taught them skills to improve day-to-day functioning and helped reduce pain. The providers felt the treatment would be a good fit for primary care as long as patient factors such as treatment expectations and ability to travel to appointments were considered. Knowing that this provider-backed intervention helped so many veterans will allow us to move forward with offering it in primary care clinics.