This is an R21 application by a new investigator to utilize Interactive Voice Response (IVR) to develop a new strategy for preventing prescription drug abuse in patients with persistent pain. IVR is a computer-based, automated telephone that enables callers to respond to a recorded voice via the telephone keypad. Using this technology, we developed Therapeutic IVR (TIVR) as an intervention in patients using prescription medication for chronic pain. The TIVR reinforces group Coping Skills Training (CST) given in our pain clinic. It includes an automated daily diary for self monitoring, guided behavioral rehearsals of key CST coping skills, and monthly personalized feedback, all of which can be accessed by patients on demand. In our pilot test, ten subjects with severe, chronic musculoskeletal pain participated in 10 weeks of group CST followed by four months of TIVR. Subsequently, we recruited a second sample of eight patients as a comparison group who were given group CST but not the TIVR. Within subjects analysis (ANOVA) of the TIVR group showed that, compared to baseline values, the maximum mean positive change for nearly all outcome measures occurred at the post TIVR point. Several measures were significantly improved post TIVR despite lack of significance after CST. These included SF-36 Mental Health Composite Score (p<.0004), MPQ pain (p<.01), CSQ Catastrophizing (p<.0006), TOPS Total Pain Experience (p<.03) and Perceived Family/Social Disability (p<.02). Between subjects analysis (ANCOVA) of TIVR treatment and comparison groups revealed significantly higher TIVR group scores for TOPS Total Pain Experience (p< .01), TOPS Perceived Social Disability (p< .002) and SF-36 Mental Composite (p< .05). Finally, Hierarchial Linear Regression of the TIVR daily diary confirmed significant reductions in the highest level of pain (p<.0001), highest stress level (p<.0001), and frequency of resorting to maladaptive coping skills such as catastrophizing (p< .0001). Analyses of these daily data also revealed a significant (.0002) decrease in the use of medication during the TIVR trial. However these latter results are tentative since we asked only two general questions about medication use, and neither question related to specific types of medication. This R21 would enable us to pretest a revised TIVR designed specifically to monitor and reduce reliance on medication and to prevent prescription drug abuse in patients with persistent pain.
| Lieberman, Gregory; Naylor, Magdalena R (2012) Interactive voice response technology for symptom monitoring and as an adjunct to the treatment of chronic pain. Transl Behav Med 2:93-101 |
| 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 |
