Review Article|Articles in Press

Barriers and facilitators of evidence-based psychotherapies for chronic pain in adults: A systematic review

  • Elizabeth S. Goldsmith
    Corresponding author: Elizabeth S. Goldsmith, MD, PhD, Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Bldg 9, Mail Code 152, One Veterans Drive, Minneapolis, MN 55417, Phone: (612) 467-2114 Fax: (612) 727-5699
    Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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  • Wendy A. Miller
    Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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  • Erin Koffel
    Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
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  • Kristen Ullman
    Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    Veterans Affairs Evidence Synthesis Program, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
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  • Adrienne Landsteiner
    Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    Veterans Affairs Evidence Synthesis Program, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
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  • Benjamin Stroebel
    Department of Dermatology, University of California – San Francisco School of Medicine, San Francisco, CA, USA
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  • Jessica Hill
    Department of Clinical Psychology, Binghamton University, Binghamton, NY, USA
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  • Princess E. Ackland
    Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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  • Timothy J. Wilt
    Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA

    Veterans Affairs Evidence Synthesis Program, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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  • Wei Duan-Porter
    Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA

    Veterans Affairs Evidence Synthesis Program, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
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      • Studied barriers/facilitators to CBT, ACT or MBSR use for chronic pain were mostly patient-level
      • Best-fit framework synthesis of evidence involved adding patient-centered subdomains to CFIR
      • Shared patient barriers included logistical conflicts and variable buy-in to therapy rationale
      • Research needed on heterogeneity of uptake, provider/system-level factors in real-world settings
      • Asynchronous formats show promise for overcoming barriers, but need effectiveness established


      Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) have demonstrated effectiveness for improving outcomes in chronic pain. These evidence-based psychotherapies (EBPs) remain underutilized in clinical practice, however. To identify research gaps and next steps for improving uptake of EBPs, we conducted a systematic review of patient-, provider-, and system-level barriers and facilitators of their use for chronic pain. We searched MEDLINE, Embase, PsycINFO, and CINAHL databases databases from inception through September 2022. Prespecified eligibility criteria included outpatient treatment of adults with chronic pain; examination of barriers and facilitators and/or evaluation of implementation strategies; conducted in the United States (US), United Kingdom (UK), Ireland, Canada or Australia; and publication in English. Two reviewers independently assessed eligibility and rated quality. We conducted a qualitative synthesis of results using a best-fit framework approach building upon domains of the Consolidated Framework for Implementation Research (CFIR). We identified 34 eligible studies (33 moderate or high quality), most (n=28) of which addressed patient-level factors. Shared barriers across EBPs included variable patient buy-in to therapy rationale and competing responsibilities for patients; shared facilitators included positive group or patient-therapist dynamics. Most studies examining ACT and all examining MBSR assessed only group formats. No studies compared barriers, facilitators, or implementation strategies of group CBT to individual CBT, or of telehealth to in-person EBPs. Conceptual mismatches of patient knowledge and beliefs with therapy principles were largely analyzed qualitatively, and studies did not explore how these mismatches were addressed to support engagement. Future research on EBPs for chronic pain in real-world practice settings is needed to explore provider and system-level barriers and facilitators, heterogeneity of effects and uptake, and both effects and uptake of EBPs delivered in various formats, including group vs. individual therapy and telehealth or asynchronous digital approaches.
      Perspective This systematic review synthesizes evidence on barriers and facilitators to uptake of cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based stress reduction for chronic pain. Findings can guide future implementation work to increase availability and use of evidence-based psychotherapies for treatment of chronic pain.
      Registration: PROSPERO number CRD42021252038

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        • Anthes E.
        Mental health: There's an app for that.
        Nature. 2016; 532: 20-23
        • Banks SM
        • Kerns RD.
        Explaining high rates of depression in chronic pain: A diathesis-stress framework.
        Psychological Bulletin. 1996; 119: 95-110
        • Bartucz MB
        • David DO
        • Matu SA.
        Cognitive vulnerabilities and Depression: A Culture-Moderated Meta-Analysis.
        Cognitive Therapy and Research. 2022; 46: 502-516
        • Bartz D
        • Chitnis T
        • Kaiser UB
        • Rich-Edwards JW
        • Rexrode KM
        • Pennell PB
        • Goldstein JM
        • O'Neal MA
        • LeBoff M
        • Behn M
        Clinical advances in sex-and gender-informed medicine to improve the health of all: a review.
        JAMA Intern Med. 2020; 180: 574-583
        • Becker WC
        • DeBar LL
        • Heapy AA
        • Higgins D
        • Krein SL
        • Lisi A
        • Makris UE
        • Allen KD.
        A Research Agenda for Advancing Non-pharmacological Management of Chronic Musculoskeletal Pain: Findings from a VHA State-of-the-art Conference.
        J Gen Intern Med. 2018; 33: 11-15
        • Becker WC
        • Dorflinger L
        • Edmond SN
        • Islam L
        • Heapy AA
        • Fraenkel L.
        Barriers and facilitators to use of non-pharmacological treatments in chronic pain.
        BMC Fam Pract. 2017; 18: 41
        • Bee P
        • McBeth J
        • MacFarlane GJ
        • Lovell K.
        Managing chronic widespread pain in primary care: a qualitative study of patient perspectives and implications for treatment delivery.
        BMC Musculoskelet Disord. 2016; 17
        • Bee PE
        • Bower P
        • Lovell K
        • Gilbody S
        • Richards D
        • Gask L
        • Roach P.
        Psychotherapy mediated by remote communication technologies: a meta-analytic review.
        BMC Psychiatry. 2008; 8: 60
        • Booth A
        • Carroll C.
        How to build up the actionable knowledge base: the role of 'best fit' framework synthesis for studies of improvement in healthcare.
        BMJ Qual Saf. 2015; 24: 700-708
        • Brintz CE
        • Roth I
        • Faurot K
        • Rao S
        • Gaylord SA.
        Feasibility and Acceptability of an Abbreviated, Four-Week Mindfulness Program for Chronic Pain Management.
        Pain Med. 2020; 21: 2799-2810
      1. Canadian Institutes of Health Research: Online Training Modules: Integrating Sex & Gender in Health Research. Available at: Accessed August 30, 2021

        • Carroll S
        • Moss-Morris R
        • Hulme K
        • Hudson J.
        Therapists' perceptions of barriers and facilitators to uptake and engagement with therapy in long-term conditions.
        Br J Health Psychol. 2021; 26: 307-324
        • Casey M-B
        • Murphy D
        • Neary R
        • Wade C
        • Hearty C
        • Doody C.
        Individuals perspectives related to acceptance, values and mindfulness following participation in an acceptance-based pain management programme.
        J Contextual Behav Sci. 2020; 16: 96-102
        • Cattanach BK
        • Thorn BE
        • Ehde DM
        • Jensen MP
        • Day MA.
        A qualitative comparison of mindfulness meditation, cognitive therapy, and mindfulness-based cognitive therapy for chronic low back pain.
        Rehabil Psychol. 2021; 66: 317-334
        • Clarke SP
        • Poulis N
        • Moreton BJ
        • Walsh DA
        • Lincoln NB.
        Evaluation of a group acceptance commitment therapy intervention for people with knee or hip osteoarthritis: a pilot randomized controlled trial.
        Disabil Rehabil. 2017; 39: 663-670
        • Collard VEJ
        • Moore C
        • Nichols V
        • Ellard DR
        • Patel S
        • Sandhu H
        • Parsons H
        • Sharma U
        • Underwood M
        • Madan J
        • Tang NKY.
        Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers.
        BMC Fam Pract. 2021; 22
        • Corbie-Smith G
        • Henderson G
        • Blumenthal C
        • Dorrance J
        • Estroff S.
        Conceptualizing race in research.
        J Natl Med Assoc. 2008; 100: 1235-1243
        • Crisp CD
        • Hastings-Tolsma M
        • Jonscher KR.
        Mindfulness-Based Stress Reduction for Military Women With Chronic Pelvic Pain: A Feasibility Study.
        Mil Med. 2016; 181: 982-989
        • Damschroder LJ
        • Aron DC
        • Keith RE
        • Kirsh SR
        • Alexander JA
        • Lowery JC.
        Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.
        Implement Sci. 2009; 4
        • Damschroder LJ
        • Hagedorn HJ.
        A guiding framework and approach for implementation research in substance use disorders treatment.
        Psychol Addict Behav. 2011; 25: 194-205
        • Diagnosis and Treatment of Low Back Pain Work Group
        VA/DoD Clinical Practice Guideline for the Diagnosis and Treatment of Low Back Pain.
        • Dieleman JL
        • Cao J
        • Chapin A
        • Chen C
        • Li Z
        • Liu A
        • Horst C
        • Kaldjian A
        • Matyasz T
        • Scott KW
        • Bui AL
        • Campbell M
        • Duber HC
        • Dunn AC
        • Flaxman AD
        • Fitzmaurice C
        • Naghavi M
        • Sadat N
        • Shieh P
        • Squires E
        • Yeung K
        • Murray CJL.
        US Health Care Spending by Payer and Health Condition, 1996-2016.
        Jama. 2020; 323: 863-884
        • Dowell D
        • Haegerich TM
        • Chou R.
        CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016.
        MMWR Recomm Rep. 2016; 65: 1-49
        • Drossman DA
        • Dumitrascu DL.
        Rome III: New standard for functional gastrointestinal disorders.
        J Gastrointestin Liver Dis. 2006; 15: 237-241
        • Fraser C
        • Beasley M
        • Macfarlane G
        • Lovell K.
        Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability.
        BMC Musculoskelet Disord. 2019; 20: 198
        • Gaskin DJ
        • Richard P.
        The economic costs of pain in the United States.
        J Pain. 2012; 13: 715-724
        • George MC
        • Wongmek A
        • Kaku M
        • Nmashie A
        • Robinson-Papp J.
        A Mixed-Methods Pilot Study of Mindfulness-Based Stress Reduction for HIV-Associated Chronic Pain.
        Behav Med. 2017; 43: 108-119
        • Goldsmith E
        • Koffel E
        • Ackland P
        • Hill J
        • Landsteiner A
        • Miller W
        • Stroebel B
        • Ullman K
        • Wilt T
        • Duan-Porter W
        Implementation of psychotherapies and mindfulness-based stress reduction for chronic pain and chronic mental health conditions, Evidence Synthesis Program, Health Services Research and Development Service.
        Office of Research and Development, Department of Veterans Affairs, Washington, DC2021 (VA ESP Project #09-009)
        • Goulet JL
        • Kerns RD
        • Bair M
        • Becker WC
        • Brennan P
        • Burgess DJ
        • Carroll CM
        • Dobscha S
        • Driscoll MA
        • Fenton BT
        • Fraenkel L
        • Haskell SG
        • Heapy AA
        • Higgins DM
        • Hoff RA
        • Hwang U
        • Justice AC
        • Piette JD
        • Sinnott P
        • Wandner L
        • Womack JA
        • Brandt CA.
        The musculoskeletal diagnosis cohort: examining pain and pain care among veterans.
        Pain. 2016; 157: 1696-1703
        • Greenhalgh T
        • Robert G
        • Macfarlane F
        • Bate P
        • Kyriakidou O.
        Diffusion of innovations in service organizations: systematic review and recommendations.
        Milbank Q. 2004; 82: 581-629
        • Guo C
        • Ashrafian H
        • Ghafur S
        • Fontana G
        • Gardner C
        • Prime M.
        Challenges for the evaluation of digital health solutions-A call for innovative evidence generation approaches.
        NPJ Digit Med. 2020; 3: 110
        • Hardeman RR
        • Murphy KA
        • Karbeah J
        • Kozhimannil KB.
        Naming Institutionalized Racism in the Public Health Literature: A Systematic Literature Review.
        Public Health Rep. 2018; 133: 240-249
        • Haskell SG
        • Ning Y
        • Krebs E
        • Goulet J
        • Mattocks K
        • Kerns R
        • Brandt C.
        Prevalence of painful musculoskeletal conditions in female and male veterans in 7 years after return from deployment in Operation Enduring Freedom/Operation Iraqi Freedom.
        Clin J Pain. 2012; 28: 163-167
        • Heapy A
        • Otis J
        • Marcus KS
        • Frantsve LM
        • Janke AE
        • Shulman M
        • Bellmore W
        • Kerns RD.
        Intersession coping skill practice mediates the relationship between readiness for self-management treatment and goal accomplishment.
        Pain. 2005; 118: 360-368
        • Heapy AA
        • Higgins DM
        • Goulet JL
        • LaChappelle KM
        • Driscoll MA
        • Czlapinski RA
        • Buta E
        • Piette JD
        • Krein SL
        • Kerns RD.
        Interactive Voice Response-Based Self-management for Chronic Back Pain: The COPES Noninferiority Randomized Trial.
        JAMA Intern Med. 2017; 177: 765-773
        • Heidari S
        • Babor TF
        • De Castro P
        • Tort S
        • Curno M.
        Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use.
        Res Integr Peer Rev. 2016; 1: 2
        • Helbach J
        • Pieper D
        • Mathes T
        • Rombey T
        • Zeeb H
        • Allers K
        • Hoffmann F.
        Restrictions and their reporting in systematic reviews of effectiveness: an observational study.
        BMC Med Res Methodol. 2022; 22: 230
        • Herman PM
        • Anderson ML
        • Sherman KJ
        • Balderson BH
        • Turner JA
        • Cherkin DC.
        Cost-effectiveness of Mindfulness-based Stress Reduction Versus Cognitive Behavioral Therapy or Usual Care Among Adults With Chronic Low Back Pain.
        Spine (Phila Pa 1976). 2017; 42: 1511-1520
        • Higgins DM
        • LaChappelle KM
        • Serowik KL
        • Driscoll MA
        • Lee A
        • Heapy AA.
        Predictors of Participation in a Nonpharmacological Intervention for Chronic Back Pain.
        Pain Med. 2018; 19: S76-S83
        • Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education
        Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.
        National Academies Press (US), Washington (DC)2011
        • Jameel S
        • Munivenkatappa M
        • Arumugham SS
        • Thennarasu K.
        Cultural adaptation of cognitive behaviour therapy for depression: a qualitative study exploring views of patients and practitioners from India.
        The Cognitive Behaviour Therapist. 2022; 15
        • Jones CP.
        Levels of racism: a theoretic framework and a gardener's tale.
        Am J Public Health. 2000; 90: 1212-1215
        • Jones SMW
        • Sherman KJ
        • Bermet Z
        • Palazzo LG
        • Lewis CC.
        An experimental study to inform adoption of mindfulness-based stress reduction in chronic low back pain.
        Implement Sci Commun. 2022; 3
        • Kabat-Zinn J.
        An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results.
        Gen Hosp Psychiatry. 1982; 4: 33-47
        • Kaiser T
        • Volkmann C
        • Volkmann A
        • Karyotaki E
        • Cuijpers P
        • Brakemeier E-L.
        Heterogeneity of treatment effects in trials on psychotherapy of depression.
        Clinical Psychology: Science and Practice. 2022; 29: 294-303
        • Karlin BE
        • Brown GK
        • Trockel M
        • Cunning D
        • Zeiss AM
        • Taylor CB.
        National dissemination of cognitive behavioral therapy for depression in the Department of Veterans Affairs health care system: therapist and patient-level outcomes.
        J Consult Clin Psychol. 2012; 80: 707-718
        • Karlin BE
        • Cross G.
        From the laboratory to the therapy room: National dissemination and implementation of evidence-based psychotherapies in the U.S. Department of Veterans Affairs Health Care System.
        Am Psychol. 2014; 69: 19-33
        • Kashner TM
        • Henley SS
        • Golden RM
        • Zhou X-H.
        Making causal inferences about treatment effect sizes from observational datasets.
        Biostatistics & Epidemiology. 2020; 4: 48-83
        • Kent DM
        • Paulus JK
        • Van Klaveren D
        • D'Agostino R
        • Goodman S
        • Hayward R
        • Ioannidis JP
        • Patrick-Lake B
        • Morton S
        • Pencina M
        The predictive approaches to treatment effect heterogeneity (PATH) statement.
        Ann Intern Med. 2020; 172: 35-45
        • Kent DM
        • Rothwell PM
        • Ioannidis JP
        • Altman DG
        • Hayward RA.
        Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal.
        Trials. 2010; 11: 85
        • Kerns RD
        • Philip EJ
        • Lee AW
        • Rosenberger PH.
        Implementation of the veterans health administration national pain management strategy.
        Transl Behav Med. 2011; 1: 635-643
        • Kerns RD
        • Rosenberg R.
        Predicting responses to self-management treatments for chronic pain: application of the pain stages of change model.
        Pain. 2000; 84: 49-55
        • Kligler B
        • Bair MJ
        • Banerjea R
        • DeBar L
        • Ezeji-Okoye S
        • Lisi A
        • Murphy JL
        • Sandbrink F
        • Cherkin DC.
        Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain.
        J Gen Intern Med. 2018; 33: 16-23
        • Koffel E
        • Vitiello MV
        • McCurry SM
        • Rybarczyk B
        • Von Korff M.
        Predictors of Adherence to Psychological Treatment for Insomnia and Pain: Analysis from a Randomized Trial.
        Clin J Pain. 2018; 34: 375-382
        • Krieger N.
        Embodying inequality: a review of concepts, measures, and methods for studying health consequences of discrimination.
        Int J Health Serv. 1999; 29: 295-352
        • Lackner JM
        • Jaccard J.
        Specific and common mediators of gastrointestinal symptom improvement in patients undergoing education/support vs. cognitive behavioral therapy for irritable bowel syndrome.
        J Consult Clin Psychol. 2021; 89: 435-453
        • Li H
        • Glecia A
        • Kent-Wilkinson A
        • Leidl D
        • Kleib M
        • Risling T.
        Transition of Mental Health Service Delivery to Telepsychiatry in Response to COVID-19: A Literature Review.
        Psychiatr Q. 2022; 93: 181-197
        • Licciardone JC.
        Demographic Characteristics Associated With Utilization of Noninvasive Treatments for Chronic Low Back Pain and Related Clinical Outcomes During the COVID-19 Pandemic in the United States.
        J Am Board Fam Med. 2021; 34: S77-S84
        • Luedtke A
        • Kessler RC.
        New Directions in Research on Heterogeneity of Treatment Effects for Major Depression.
        JAMA Psychiatry. 2021; 78: 478-480
        • Marikar Bawa FL
        • Sutton JW
        • Mercer SW
        • Bond CM
        I'm empowered to look after myself" - Mindfulness as a way to manage chronic pain: An interpretative phenomenological analysis of participant experiences in Scotland.
        Soc Sci Med. 2021; 281114073
        • Martinez ME
        • Kearney DJ
        • Simpson T
        • Felleman BI
        • Bernardi N
        • Sayre G.
        Challenges to Enrollment and Participation in Mindfulness-Based Stress Reduction Among Veterans: A Qualitative Study.
        J Altern Complement Med. 2015; 21: 409-421
        • McCracken LM
        • Sato A
        • Wainwright D
        • House W
        • Taylor GJ.
        A feasibility study of brief group-based acceptance and commitment therapy for chronic pain in general practice: recruitment, attendance, and patient views.
        Prim Health Care Res Dev. 2014; 15: 312-323
        • McGuire A
        • Matthias MS
        • Kukla M
        • Henry N
        • Carter J
        • Flanagan M
        • Bair MJ
        • Murphy JL.
        A National Survey of Patient Completion of Cognitive Behavioral Therapy for Chronic Pain: The Role of Therapist Characteristics, Attempt Rates, and Modification.
        Prof Psychol Res Pr. 2021; 52: 542-550
        • McWilliams LA
        • Cox BJ
        • Enns MW.
        Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample.
        Pain. 2003; 106: 127-133
        • Mun CJ
        • Otis JD
        • Concato J
        • Reid MC
        • Burg MM
        • Czlapinski R
        • Kerns RD.
        Further Examination of the Pain Stages of Change Questionnaires Among Chronic Low Back Pain Patients: Long-term Predictive Validity of Pretreatment and Posttreatment Change Scores and Stability of Posttreatment Scores.
        Clin J Pain. 2019; 35: 744-752
        • Murphy JL
        • Cordova MJ
        • Dedert EA.
        Cognitive behavioral therapy for chronic pain in veterans: Evidence for clinical effectiveness in a model program.
        Psychol Serv. 2022; 19: 95-102
        • Nahin RL.
        Severe Pain in Veterans: The Effect of Age and Sex, and Comparisons With the General Population.
        J Pain. 2017; 18: 247-254
        • Okvat HA
        • Davis MC
        • Mistretta EG
        • Mardian AS.
        Mindfulness-based training for women veterans with chronic pain: A retrospective study.
        Psychol Serv. 2022; 19: 106-119
        • Patel S
        • Peacock SM
        • McKinley RK
        • Clark-Carter D
        • Watson PJ.
        GPs' perceptions of the service needs of South Asian people with chronic pain: a qualitative enquiry.
        J Health Psychol. 2009; 14: 909-918
        • Piette JD
        • Newman S
        • Krein SL
        • Marinec N
        • Chen J
        • Williams DA
        • Edmond SN
        • Driscoll M
        • LaChappelle KM
        • Kerns RD
        • Maly M
        • Kim HM
        • Farris KB
        • Higgins DM
        • Buta E
        • Heapy AA.
        Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: A Randomized Comparative Effectiveness Trial.
        JAMA Intern Med. 2022; 182: 975-983
        • Powell BJ
        • McMillen JC
        • Proctor EK
        • Carpenter CR
        • Griffey RT
        • Bunger AC
        • Glass JE
        • York JL.
        A compilation of strategies for implementing clinical innovations in health and mental health.
        Med Care Res Rev. 2012; 69: 123-157
        • Racine M.
        Chronic pain and suicide risk: A comprehensive review.
        Prog Neuropsychopharmacol Biol Psychiatry. 2018; 87: 269-280
        • Radziwon CD
        • Quigley BM
        • Vargovich AM
        • Krasner SS
        • Gudleski GD
        • Mason SR
        • Borden AB
        • Lackner JM.
        Do I really have to do my homework? The role of homework compliance in cognitive behavioral therapy for irritable bowel syndrome.
        Behav Res Ther. 2022; 152104063
        • Safaeinili N
        • Brown-Johnson C
        • Shaw JG
        • Mahoney M
        • Winget M.
        CFIR simplified: Pragmatic application of and adaptations to the Consolidated Framework for Implementation Research (CFIR) for evaluation of a patient-centered care transformation within a learning health system.
        Learn Health Syst. 2020; 4: e10201
        • Scott W
        • Guildford BJ
        • Badenoch J
        • Driscoll E
        • Chilcot J
        • Norton S
        • Kemp HI
        • Lee MJ
        • Lwanga J
        • Boffito M
        • Moyle G
        • Post FA
        • Campbell L
        • Josh J
        • Clift P
        • CdCW A
        • Rice AS
        • McCracken LM
        Feasibility randomized-controlled trial of online acceptance and commitment therapy for painful peripheral neuropathy in people living with HIV: The OPEN study.
        Eur J Pain. 2021; 25: 1493-1507
        • Sherman KJ
        • Wellman RD
        • Jones SMW
        • Lewis CC.
        Interest in Mindfulness Training for Chronic Low-Back Pain: Results from a Vignette-driven, Web-based Survey of Patients.
        J Integr Complement Med. 2022; 28: 484-496
        • Singh J.
        Critical appraisal skills programme.
        Journal of pharmacology and Pharmacotherapeutics. 2013; 4: 76
        • Solomonov N
        • Lee J
        • Banerjee S
        • Fluckiger C
        • Kanellopoulos D
        • Gunning FM
        • Sirey JA
        • Liston C
        • Raue PJ
        • Hull TD
        • Arean PA
        • Alexopoulos GS.
        Modifiable predictors of nonresponse to psychotherapies for late-life depression with executive dysfunction: a machine learning approach.
        Mol Psychiatry. 2021; 26: 5190-5198
        • Stewart MO
        • Karlin BE
        • Murphy JL
        • Raffa SD
        • Miller SA
        • McKellar J
        • Kerns RD.
        National dissemination of cognitive-behavioral therapy for chronic pain in veterans: therapist and patient-level outcomes.
        Clin J Pain. 2015; 31: 722-729
        • Stewart MO
        • Raffa SD
        • Steele JL
        • Miller SA
        • Clougherty KF
        • Hinrichsen GA
        • Karlin BE.
        National dissemination of interpersonal psychotherapy for depression in veterans: therapist and patient-level outcomes.
        J Consult Clin Psychol. 2014; 82: 1201-1206
        • Sweeney L
        • Moss-Morris R
        • Czuber-Dochan W
        • Norton C.
        Pain management in inflammatory bowel disease: feasibility of an online therapist-supported CBT-based self-management intervention.
        Pilot feasibility stud. 2021; 7
        • Thorn BE
        • Day MA
        • Burns J
        • Kuhajda MC
        • Gaskins SW
        • Sweeney K
        • McConley R
        • Ward CL
        • Cabbil C.
        Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain.
        Pain. 2011; 152: 2710-2720
        • U. S. Burden of Disease Collaborators
        The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States.
        Jama. 2018; 319: 1444-1472
        • Use of Opioids in the Management of Chronic Pain Work Group
        VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain.
        • Valenstein-Mah H
        • Greer N
        • McKenzie L
        • Hansen L
        • Strom TQ
        • Wiltsey Stirman S
        • Wilt TJ
        • Kehle-Forbes SM
        Effectiveness of training methods for delivery of evidence-based psychotherapies: a systematic review.
        Implement Sci. 2020; 15
        • Van Dyke BP
        • Newman AK
        • Morais CA
        • Burns JW
        • Eyer JC
        • Thorn BE.
        Heterogeneity of Treatment Effects in a Randomized Trial of Literacy-Adapted Group Cognitive-Behavioral Therapy, Pain Psychoeducation, and Usual Medical Care for Multiply Disadvantaged Patients With Chronic Pain.
        J Pain. 2019; 20: 1236-1248
        • Van Huet H
        • Innes E
        • Whiteford G.
        Living and doing with chronic pain: narratives of pain program participants.
        Disabil Rehabil. 2009; 31: 2031-2040
        • VanDenKerkhof EG
        • Carley ME
        • Hopman WM
        • Ross-White A
        • Harrison MB.
        Prevalence of chronic pain and related risk factors in military veterans: a systematic review.
        JBI Database Syst Rev Implement Rep. 2014; 12: 152-186
        • Verhey IJ
        • Ryan GK
        • Scherer N
        • Magidson JF.
        Implementation outcomes of cognitive behavioural therapy delivered by non-specialists for common mental disorders and substance-use disorders in low- and middle-income countries: a systematic review.
        Int J Ment Health Syst. 2020; 14
        • Veterans Health Administration
        Pain Management VHA Directive 2009-053.
        Department of Veterans Affairs, Washington, DC2009
        • Walser RD
        • Karlin BE
        • Trockel M
        • Mazina B
        • Barr Taylor C
        Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: therapist and patient outcomes.
        Behav Res Ther. 2013; 51: 555-563
      2. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000

        • Wetherell JL
        • Petkus AJ
        • Alonso-Fernandez M
        • Bower ES
        • Steiner AR
        • Afari N.
        Age moderates response to acceptance and commitment therapy vs. cognitive behavioral therapy for chronic pain.
        Int J Geriatr Psychiatry. 2016; 31: 302-308
        • Yu W
        • Ravelo A
        • Wagner TH
        • Phibbs CS
        • Bhandari A
        • Chen S
        • Barnett PG.
        Prevalence and costs of chronic conditions in the VA health care system.
        Med Care Res Rev. 2003; 60: 146S-167S
        • Zajacova A
        • Grol-Prokopczyk H
        • Zimmer Z.
        Pain Trends Among American Adults, 2002-2018: Patterns, Disparities, and Correlates.
        Demography. 2021; 58: 711-738