Targeting Chronic Pain in Primary Care Settings Using Behavioral Health Consultants: A Pilot Study Implementing Brief Cognitive Behavioral Therapy for Chronic Pain

Chronic pain is common among military service members, retirees, and families, yet non-pharmacologic options in primary care are limited. This pilot study evaluated the feasibility, and outcomes of Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) delivered by integrated Behavioral Health Consultants (BHCs) in a Military Health System (MHS) clinic. This prospective, observational pragmatic pilot study recruited 44 Department of Defense beneficiaries (M age = 44.5 years [SD = 9.3 years]; 75% female; 50% Caucasian; 47.7% military family members, 38.6% retirees) with chronic pain (≥ 12 weeks). As part of usual care, participants received BCBT-CP, a modular skills-based intervention delivered within the Primary Care Behavioral Health model. Measures included the Defense and Veterans Pain Rating Scale (DVPRS), the Pain, Enjoyment of Life, and General Activity (PEG-3) scale, and the Behavioral Health Measure (BHM-20), assessed at baseline, during treatment, and 3- and 6-months after the baseline assessment. Feasibility was high, with 44 of 45 approached patients enrolling in the study. These participants attended a median of 3 appointments (IQR 2-6) over 52 days (IQR 22-110.5). Significant improvements were observed on DVPRS pain intensity (p < .001) and interference with activity, sleep, and stress. PEG total and subscales also improved (p < .05). No significant changes were detected on the BHM-20. Follow-up outcome data suggested partial loss of gains due to small sample size and attrition. Using BHCs to implement BCBT-CP in MHS primary care is feasible and improves short-term pain outcomes. Larger trials should test strategies to sustain benefits.