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Center for Care Delivery and Outcomes Research

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Evidence-Based Psychotherapies for Chronic Pain

Chronic pain conditions comprise three of the top five causes of disability in the United States (US) and contribute to other disabling conditions including opioid use disorder. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) have demonstrated effectiveness for mental health conditions including depression and anxiety, and have more recently shown effectiveness for improving chronic pain outcomes. Nonetheless, these evidence-based psychotherapies (EBPs) remain underused and underaccessed in clinical settings. To identify research areas critical for improving uptake of EBPs for chronic pain, the VA Health Services Research & Development (HSR&D) Pain/Opioid Consortium of Research (CORE) requested an evidence review on barriers, facilitators, and implementation strategies for EBPs in chronic pain. Our review addressed the following key questions:

1. For cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based therapy used to treat adults with chronic pain:
           a) What are the patient-, provider-, and system-level barriers and facilitators for treatment uptake?
           b) What is the effect of implementation strategies to increase uptake of these treatments?
        Find a summary of results here: Click here

2. For evidence-based psychotherapies and mindfulness-based interventions used in integrated delivery systems to treat adults with chronic mental health conditions:
          a) What are the provider- and system-level barriers and facilitators to treatment uptake?
          b) What is the effect of implementation strategies to increase uptake of these treatments?
        Find a summary of results here: Click here

The full evidence synthesis report is available here:
https://www.hsrd.research.va.gov/publications/esp/Psychotherapies-Pain.cfm
Goldsmith ES, Koffel E, Ackland P, Hill J, Landsteiner A, Miller W, Stroebel B, Ullman K, Wilt T, and Duan-Porter W. Implementation of Psychotherapies and Mindfulness-based Stress Reduction for Chronic Pain and Chronic Mental Health Conditions. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; 2021.