Therapeutic Interactive Voice Response Appears to Decrease Pain and Increase Coping Ability in Chronic Pain

When chronic pain cannot be resolved with medications and treatment, self-management may help decrease the intensity of the pain and increase the ability to cope with it. Earlier studies have shown that use of a program called Therapeutic Interactive Voice Response (TIVR) was beneficial for patients for a short period. The authors of this study wanted to see if a TIVR-based intervention could have good effects over a longer period, increasing treatment compliance and adherence, allowing for better outcomes to treatment.

The researchers enrolled 50 patients who had history of chronic pain. After the patients participated in a cognitive behavioral therapy (CBT) program to work on decreasing maladaptive behavior associated with pain and helping patients use attention diversions and activity patterns, they were randomized into two equal groups, one that would participate in the TIVR program and the other would not.

The TIVR system consisted of four parts: daily self-monitoring through a questionnaire, an instructional review of coping skills and techniques, pre-recorded behavioral rehearsals of coping skills, and monthly feedback from a CBT who based the review on the daily reports received for each patient.

Patient assessments were done through the McGill Pain Questionnaire (MPQ) and the Enhanced SF-36 Total Pain Symptoms (TOPS). After the patients were randomized, the treatment group continued on with the TIVR program. The daily questionnaire consisted of 21 questions to be completed by phone. Questions cover topics such as pain medications used during that day, stress, and daily coping. The instructional review was available to the patients that helped reinforce the eight pain management techniques they learned during the CBT sessions. The third part of the program, the guided behavior rehearsal allowed patients to access rehearsals of the eight coping techniques through the phone. Finally, every month, the therapist would review the responses and use of reviews and rehearsals, and record pertinent messages individual to each patient.

The researchers found that, overall, the treatment group had a statistically significant improvement in maintaining all outcomes than did the control group. They continued to maintain improvements in the four months after the treatment period ended - a total of eight months since the start of the study. Although the non-treatment group did show improvement during the CBT sessions before the randomization, this was not maintained in the four months of the study.

The patients were assessed before the study, before the randomization, after the study, and again at eight months after the study began.

The authors acknowledged that there may have been some improvement in some patients because of medication use and the do point out some weaknesses in the study: the group was small and the study follow-up was short. However, the authors conclude that using TIVR as a coping skill could help in managing skills to cope with chronic pain and to help in controlling relapses.

Magdalena R. Naylor, et al. Therapeutic Interactive Voice Response for chronic pain reduction and relapse prevention. In Pain January 2008. Vol. 134. Pp. 335-345.



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