We propose to explore a well-known telephone-based technology (IVR) as a tool to reduce the pain, physical disability, and psychological distress experienced by patients with chronic musciiloskeletal pain. IVR (Interactive Voice Response) is a computer-based, automated telephone system that enables callers to respond to a recorded voice via the telephone keypad. Using this technology, we developed Therapeutic IVR (TIVR) as a tool for maintenance enhancement fallowing group cognitive-behavioral coping skills training (CST), a widely used behavioral treatment for chronic pain. The TFVR has four components: 1) an automated daily questionnaire for self monitoring, 2) a didactic review of coping skills, 3) guided behavioral rehearsals of CST coping skills, and 4) monthly feedback messages recorded on to the TIVR by the therapist. All four components can be accessed remotely by patients via any touch-tone phone. We initially tested the feasibility of the TIVR in a convenience pilot sample of 18 subjects. Ten patients with severe, chronic musculoskeletal pain participated in 11 weeks of group CST followed by four months of TIVR. A comparison sample of eight subjects received the same group CST by the same therapist, but not the TIVR. Both groups showed improvement after CST. However, between subjects analysis across the two groups showed that relevant outcome scores in the comparison sample worsened in the four months after CST whereas the same outcomes in the TIVR group improved during this period. In a second (ongoing) pilot study funded by a NIDA R21 grant, we are attempting to determine if the TIVR can be used to improve coping, decrease pain and reduce pain medication use. Study design and outcome measures are similar to those of the initial pilot study except that subjects are randomized. We have now analyzed data from 34 subjects, 15 probands and 19 controls. Preliminary results on the efficacy of the TIVR confirm the results of the initial pilot study. Between subjects analysis (ANCOVA) revealed statistically significant inter-group differences in: TOPS Pain Symptoms, TOPS Total Pain Experience, SF-36 Physical Composite, and CSQ Ability to Control Pain at both 4 and 8 months follow-up. The present R01 application is for a randomized controlled trial (RCT) of the TIVR in 150 patients with chronic musculoskeletal pain. We propose a 3-arm study. As before, all subjects will be given our standard 11 weeks of CST for pain coping skills. Consenting subjects will then be randomly assigned to one of three study conditions: 1) a no TIVR control condition (standard treatment);2) an attention control condition, four months of calls to the Daily Self-monitoring Questionnaire with minimum monthly feedback;or 3) the full TIVR condition, four months of calls to the Full TIVR (all four components). The study goals are: 1) to attempt to replicate the results of the two pilot studies of TIVR in a full-scale RCT;and 2) to determine the efficacy of the full TIVR in relation to an attention control condition.
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| Naylor, Magdalena R; Krauthamer, G Michael; Naud, Shelly et al. (2011) Predictive relationships between chronic pain and negative emotions: a 4-month daily process study using Therapeutic Interactive Voice Response (TIVR). Compr Psychiatry 52:731-6 |
| Naylor, Magdalena R; Naud, Shelly; Keefe, Francis J et al. (2010) Therapeutic Interactive Voice Response (TIVR) to reduce analgesic medication use for chronic pain management. J Pain 11:1410-9 |
| Naylor, Magdalena R; Keefe, Francis J; Brigidi, Bart et al. (2008) Therapeutic Interactive Voice Response for chronic pain reduction and relapse prevention. Pain 134:335-45 |
