Trends in engagement with cognitive-behavioral therapy for chronic pain conditions after referral

Cognitive-behavioral therapy for chronic pain (CBT-CP) is an important evidence-based non-pharmacologic treatment for chronic back and neck pain that is frequently recommended as a component of multidisciplinary treatment. However, the success of CBP-CP’s implementation in clinical settings is affected by a variety of poorly understood obstacles to patient engagement with CBT-CP. Expanding upon the limited prior research conducted in heterogeneous practice settings, this study examines patterns of treatment initiation for CBT-CP at an interdisciplinary, hospital-based chronic pain practice and conducts exploratory comparisons between groups of patients who did and did not engage in CBT-CP after receiving a referral. Patients’ descriptive data, including pain severity, work status, prior therapy, and behavioral health questionnaire scores at intake visit, were obtained through a retrospective chart review of electronic medical records. Data were then analyzed using inter-group comparisons and logistic regression modeling to determine factors that predicted treatment initiation for CBT-CP. On multivariate analysis, we found that patient’s depression level as measured by their Patient Health Questionnaire 9 (PHQ-9) score was solely predictive of treatment initiation, as chronic pain patients with a higher level of depression were found to be more likely to attend their recommended appointments of CBT-CP. Anxiety score as measured by GAD-7, work status, pain scores, and prior therapy engagement were not independently predictive. No single “profile” of patient-level factors was found to delineate patients who did and did not initiate CBT-CP, demonstrating the limitations of clinical variables as predictors of uptake. In an interdisciplinary chronic pain practice, patient likelihood to engage with recommended cognitive-behavioral therapy was only predicted by depression (PHQ-9) score at baseline visit, demonstrating the limitations of a purely clinical approach to treatment uptake. Lay Summary Cognitive-behavioral therapy (CBT) is a frequently used therapy option, and can be helpful for patients with chronic low back and/or neck pain. However, patients do not always choose to engage in CBT when offered in the context of chronic pain. Reasons patients choose not to pursue CBT, when recommended, are not well understood. This study used data from a hospital-based chronic pain practice in order to identify reasons that patients choose to begin CBT and those who do n