Telephone-Based Program for Coping with Pain

Many treatment methods have been devised to treat chronic pain. But the Therapeutic Interactive Voice Response (TIVR) may be the first to prevent relapse months later.

The TIVR is an automated, telephone-based tool used for patients with chronic musculoskeletal pain. It was developed at the University of Vermont along with Duke University Medical School.

Patients using the TIVR were treated first in an 11-week cognitive-behavioral therapy (CBT) program. CBT included education about pain and the effect of chronic pain on people. Coping strategies using new patterns of thought and feelings were part of each CBT session. CBT also included relaxation, pacing, and distraction techniques. The importance of social support was also discussed.

Once the CBT was completed, then the patients did four months of the TIVR program. A second (control) group was used to compare the results of TIVR. The control group received CBT but not TIVR.

CBT recognizes the need to practice coping skills on a regular (even daily) basis. The TIVR has four parts to give patients the kind of daily self-monitoring needed to be successful in pain management. The program is accomplished using a touch-tone telephone to call-in.

These four components include 1) a set of 21 questions to answer every day (self-monitoring), 2) reminder of eight coping skills learned during CBT, 3) a guided session of coping skills that can be practiced, and 4) personalized return messages from a CBT therapist. The last part (monthly encouragement and feedback from the therapist) is based on a review of the patient's daily report.

Both groups improved after CBT. Pain, function, disability, and coping were used to measure the results. Medication use (pain relievers, antiinflammatories, antidepressants) was also monitored before and after treatment.

The control group then declined and got worse over the next four months. At the same time, the CBT plus TIVR group did not relapse (get worse). In fact, the TIVR group continued to get better for months after the TIVR ended.

The results of this study support the use of a self-monitoring follow-up program after CBT for patients with chronic pain. Mastering the skill and improved self-monitoring may be what made the difference. After learning new coping skills, the TIVR made it possible for patients to continue practicing those skills.

Further research may validate the use of the TIVR as a tool to prevent pain behavior relapse. Future studies will determine if all four components of the TIVR are needed for success. It may be that patients only need one or two of the steps provided.