Over 100 million American adults are burdened with chronic pain. Chronic pain is typically associated with medication prescriptions and frequent visits to the doctor. However, a critical component of chronic pain often goes untreated: mental health.
Pain As A Trigger For Anxiety and Depression
Pain is a known trigger for depression, anxiety, and stress. In fact, depression occurs with chronic pain in over 20% of cases, resulting in increased healthcare utilization, worsening pain severity, and poor outcomes after surgery. Therefore, patients who suffer from chronic pain stand to benefit from behavioral therapy interventions.
Behavioral therapy is a proven cost-efficient and clinically effective way to address both pain and its mental health comorbidities. Unfortunately, however, many individuals who suffer from chronic pain with depressive symptoms do not receive comprehensive care.
Barriers To Behavioral Therapy
Access to behavioral therapy for the chronic pain population is limited by a multitude of factors, including stigma, cost, geography, and system-wide barriers. Additionally, patients with chronic pain who would likely benefit from behavioral therapy are often not identified. And of those who are referred to therapy, ⅔ of patients fail to complete their prescribed treatment programs.
Telehealth provides a solution to this problem. Telehealth delivered behavioral therapy (telebehavioral therapy) for chronic pain removes many of the barriers that limit access to care for this patient population.
Behavioral Therapy Delivered Through Telehealth
A study published in August 2017 proves this very point. The study outlines a nationally scaled telebehavioral health program for patients with chronic pain. The participants in the study participated in an eight week telebehavioral program for chronic pain that sought to address the behavioral comorbidities of pain, such as depression, anxiety, and stress.
A licensed social worker or a behavioral coach carried out the telehealth behavioral interventions over phone or telehealth video conferencing. The clinical content was multifactorial and included cognitive behavioral therapy, acceptance and commitment therapy, mindfulness, distress tolerance, and motivational interviewing. Therapists and behavioral coaches were able to personalize the program to cater to each individual’s unique needs.
The therapists objectively measured the participants’ mental health using the validated Depression Anxiety Stress Scales (DASS-21). Qualitative data was also gathered to gain insight into the participants’ mood triggers, chief complaints of pain, and long term goals. Data was collected before and after the program, as well as intermittently throughout treatment.
Over the course of treatment, the therapists worked with participants to establish treatment goals, as well as to address the psychological factors that were associated with their chronic pain. Therapists also worked with participants to address any barriers to treatment adherence, a factor that frequently limits the success of behavioral therapy.
After completing the program, the study participants demonstrated significant improvements in depression, anxiety, and stress scores. Additionally, more than half of participants (52%) with depression scores that were elevated at baseline presented with normal scores upon completion of the program. Anxiety and stress scores followed suit, with 49% of participants with anxiety scores and 50% of participants with stress scores transitioning to normal scores by the end of the program.
This study demonstrates the power of telehealth to address behavioral health. Behavioral therapy is a critical piece of healthcare in general, yet it is often ignored or missing from patient care. Telehealth presents providers with an opportunity to close this gap in care and take a more holistic approach to the treatment of chronic pain.
Beyond Behavioral Therapy
It’s also worth noting that the implications of this study reach far beyond the chronic pain population. Studies have demonstrated benefits of telebehavioral therapy in various medical populations, such as patients with diabetes and hypertension.
When included in the treatment of any multifactorial condition, telehealth behavioral interventions have great potential to raise the standard of care and significantly improve quality of life. As research continues to develop in this space, more care providers are sure to realize that by using telehealth to address all components of a patient's condition, they can give their patients a chance to truly thrive.
Mochari-Greenberger H, Peters A, Vue L. A Nationally Scaled Telebehavioral Health Program for Chronic Pain: Characteristics, Goals, and Psychological Outcomes. Telemed J E Health. 2017 Aug;23(8):640-648.
Aburizik A, Dindo L, Kaboli P, et al. A pilot randomized controlled trial of a depression and disease management program delivered by phone. J Affect Disord 2013;151:769–774.