Benefits of a Single-Session Pain Skills Class Last for 6 Months in People With Chronic Low-Back Pain
A single 2-hour pain relief skills class continues to reduce pain catastrophizing, pain intensity, and pain bothersomeness in people with chronic low-back pain after 6 months and is no less effective than an 8-session cognitive behavioral therapy (CBT) program, according to a study from Stanford University, partly funded by the National Center for Complementary and Integrative Health. These results, published in the journal Pain Reports, extend the findings of a 3-month evaluation and show that the effects of the pain skills class don’t deteriorate significantly from 3 to 6 months.
CBT programs have been recommended as a first-line treatment for patients with back pain and may help to improve multiple symptoms. However, because there is a need for multiple sessions with trained practitioners, it can be difficult for health care systems to provide these relatively lengthy treatment programs and for patients to participate. The Empowered Relief program, evaluated in this study, is a briefer option that might reduce barriers to care and enable more people to participate. It consists of a 2-hour single-session pain relief skills class that includes cognitive behavioral skills, mindfulness principles, and pain neuroscience education.
In the original study, 263 adults with chronic low-back pain were randomly assigned to Empowered Relief, an 8-session (16-hour) group CBT program, or a single 2-hour back pain health education class that did not teach pain management skills. It was previously reported that after 3 months, participants in either Empowered Relief or CBT had clinically meaningful reductions in pain catastrophizing (a pattern of response that includes paying a lot of attention to the pain and feeling helpless), as well as other outcomes such as pain intensity. Both treatments were significantly more helpful than the health education class at the 3-month evaluation.
This new report describes results after 6 months. At that time, participants randomly assigned to Empowered Relief maintained the benefits seen at 3 months and showed further decreases in pain catastrophizing, pain bothersomeness, and anxiety. The effects of Empowered Relief continued to be comparable to those of CBT and better than those of the health education class.
These results show strong stability of Empowered Relief and support its value as an effective behavioral pain treatment that requires relatively little provider and patient time and cost. However, questions remain about individual differences in responses to Empowered Relief and multisession CBT and about the impact of Empowered Relief in diverse populations and for conditions other than chronic low-back pain. A study currently in progress is comparing Empowered Relief with 8-session CBT in a large, diverse sample of adults with a variety of chronic pain conditions; both interventions are being delivered online, rather than in in-person classes. The results of that study and other ongoing research will help inform decisions about whether Empowered Relief should be broadly adopted in clinical practice.
- Darnall BD, Burns JW, Hong J, et al. Empowered Relief, cognitive behavioral therapy, and health education for people with chronic pain: a comparison of outcomes at 6-month follow-up for a randomized controlled trial. Pain Reports. 2024;9(1):e1116.
Publication Date: January 25, 2024