By Kate Malicke
For people with chronic pain looking for answers, the question isn’t just about finding the right treatment — it’s also about being able to reliably access that treatment.
Injections and other medical interventions can provide temporary relief.
Developing cognitive behavioral therapy skills — like improving sleep habits, learning techniques to reduce stress and reframing unhelpful thought patterns — may also help, but patients don’t always have access to qualified therapists.
A University of Michigan study published in Regional Anesthesia & Pain Medicine suggests that a new, mostly digital program supported by trained medical assistants may help reduce how much pain interferes with day-to-day life for people with chronic pain.
The study tested a program called Promoting Resilience with Innovative Self-Management, which combines traditional cognitive behavioral therapy skills for pain with additional activities intended to promote resilience and positive emotion.
Participants were randomized to this program with CBT, standard CBT for pain or usual care.
While patients in the group saw similar overall results as those in the other groups at the end of the eight-week program, researchers noted a significant long-term improvement in symptom impact (a global measure of fibromyalgia-related health and function) versus usual care a year later.
What’s more, patients in the group showed superior improvements in pain interference — or how pain hinders someone’s daily activities — throughout the duration of the study.
“Pain relief is important, but for many people the win is being able to live more fully — to live a richer life and to engage in life with less disruption,” said Afton L. Hassett, PsyD, an Associate Professor of Anesthesiology who led the study along with fellow anesthesiology colleague David A. Williams, Ph.D.
“What stood out in this study was the improvement in pain interference, and that advantage persisted over time.”
The study included nearly 300 adults with chronic back or neck pain and high levels of fibromyalgia symptoms — patients who have widespread pain, often along with sleep issues, trouble thinking, fatigue and mood problems.
Patients in all three groups received usual care through a specialty pain clinic setting, including physician visits, medications, injections and physical therapy.
Those in the program and CBT also completed weekly online CBT for pain modules with brief coaching check-ins.
Promoting Resilience with Innovative Self-Management and CBT builds on established CBT skills with resilience-building exercises focused on gratitude, acts of kindness and savoring.
Traditionally, patients using CBT for pain have met with doctoral-level specialists.
In this study, though, trained medical assistants supported patients in the CBT and Promoting Resilience with Innovative Self-Management-CBT groups through their modules.
“Access is one of the biggest barriers to behavioral pain care,” Hassett said.
“Medical assistants already have strong relationships with patients and are embedded in clinical teams. With training and support, they can help coach evidence-based skills that patients can keep using long after the program ends.”
Beth Burgess, a senior medical assistant at the Michigan Medicine Back and Pain Center, supported the recruitment and training efforts of medical assistants for this study.
“Medical assistants are the front line in clinical care, with real-life experiences from patients that help guide our work,” she said.
“With the appropriate time allotment and seeing results from studies like this involving MAs, there may be more interest from MAs [in continuing this work].”
Patients and clinicians interested in skills-based pain self-management can explore resources used in this study through PainGuide, an open-access resource with videos, exercises and downloadable tools.
“The skills that patients learn in behavioral therapies — including those therapies with a resilience-based approach — can enhance the effect of usual care and become habits that support improved long-term outcomes,” Hassett said.
Additional authors: Terri Voepel-Lewis, Guohao Zhu, Acacia Parks, Alexander Tsodikov, Joseph Long, Sana Shaikh, Chad M. Brummett, Daniel J. Clauw, David A. Williams.
Funding/disclosures: This research was funded by a grant from the National Institutes of Health – National Institute of Nursing Research, R0I NR017096.
Tech transfer(s)/Conflict(s) of interest: Hassett receives royalties from Tonix Pharmaceuticals for a digital pain self-management tool, and for a pain self-management book she authored; she is a consultant for two companies that support behavioral care for chronic pain, Community Health Focus, Inc. And Circumstance Health; and is a principal- and co-investigator for several pain research awards funded by the National Institutes of Health (NIH), including the current study. Williams is a consultant to Swing Therapeutics and Community Health Focus, Inc.; he also receives royalties from Tonix Pharmaceuticals for a digital pain self-management tool; and is a principal- and co-investigator on several NIH funded pain research projects. Full COI available online.
Paper cited: “A Randomized Controlled Trial of Medical Assistant-Coached Behavioral Intervention for Chronic Pain,” Regional Anesthesia & Pain Medicine. DOI: 10.1136/rapm-2025-107389
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Previously Published on michiganmedicine.org with Creative Commons License
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