Cognitive Behavioral Therapy for Chronic Pain

High out-of-pocket costs, geographic limitations, and literacy concerns can affect access to CBT-CP; adaptations and alternative delivery modalities exist, but more research is needed to understand how effective and acceptable these are for individuals receiving care.

Cognitive Behavioral Therapy – Evidence Rating: Low to Moderate Quality

Evidence describing cognitive behavioral therapy for pain comes from multiple systematic reviews citing low to moderate quality evidence. These reviews draw from randomized control trials that sampled from populations with conditions including low back pain, fibromyalgia, and neck pain. Trials included in these systematic reviews generally had small sample sizes and did not report long-term outcomes, which limited the quality of their findings. Studies examining real-world application of CBT-CP have more consistently identified patient-level barriers to its uptake, but future research is needed to understand for whom CBT-CP is most efficacious, as well as provider- and system-level barriers to its use.

Evidence-based Scale

While persons with chronic pain, especially those with high levels of disability, would strongly benefit from CBT-CP, they are likely to experience prohibitive, high out-of-pocket costs for these services. In 2017, only 20% of Medicaid plans covered psychological services for pain.

More research is needed to understand how cultural, demographic, and social factors affect individuals’ views or experiences of CBT-CP and their relationships with providers.

Adaptations like “Learning About My Pain (LAMP),” a literacy-adapted CBT-CP protocol, telehealth delivery, and availability of online CBT-informed programs exist. It is unclear how effective or acceptable these adaptations are compared to standard CBT-CP.