Group-format pain reprocessing therapy in veterans with chronic back/neck pain: A pilot study with mixed methods evaluation.

Pain reprocessing therapy (PRT) has demonstrated efficacy for chronic back pain as delivered individually and in-person. To enhance scalability, we developed and implemented group-format telehealth PRT delivered in 8 weekly sessions. We tested this intervention in an uncontrolled pilot trial in Veterans with chronic back/neck pain (CBNP; N=46, NCT06406699). We enrolled four cohorts and conducted focus groups with each cohort following treatment. Based on feedback from the first two cohorts, we modified the treatment protocol. Primary outcomes were feasibility, assessed via attendance and retention, and acceptability, assessed via focus group data and a Global Impression of Change scale. Clinical change was measured with PEG scores at post-treatment and 2-month follow-up. Forty-six participants enrolled, with 8 treatment dropouts and 4 lost to follow up at post-treatment assessment (73.9% retention). 32 (76%) participants attended 7 or 8 sessions, M (SD) = 6.9 (1.8) sessions attended. In focus groups, Veterans reported treatment to be acceptable, and all but one reported feeling the same or better in global impressions of change. Baseline PEG scores were M = 6.4 (1.67), with a -1.48 (1.67) point reduction at post-treatment and -0.93 (1.91) at 2-month follow-up across the four cohorts. The latter two cohorts receiving the improved treatment protocol reported a -1.46 (1.60) pain reduction at 2-month follow-up, relative to only a -0.27 (2.07) reduction in the first two cohorts. Overall, group-format PRT was both acceptable and feasible for Veterans, with clinical data showing potential clinical efficacy especially with the improved treatment protocol. PERSPECTIVE: This uncontrolled pilot trial evaluated group-format Pain Reprocessing Therapy (PRT) in Veterans with CBNP. Overall, this novel group treatment modality was both feasible and acceptable for Veterans. Following refinement after the first two cohorts, group-format PRT demonstrated potential clinical efficacy.