{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:38:55Z","timestamp":1772843935692,"version":"3.50.1"},"reference-count":34,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health -National Institute of Nursing Research","award":["R0I NR017096"],"award-info":[{"award-number":["R0I NR017096"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2026,2,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic spinal pain with widespread symptoms often responds poorly to peripherally focused treatments. Cognitive-behavioral therapy (CBT) can help but typically yields modest effects. This trial evaluated whether adding resilience-enhancing activities to medical assistant-coached CBT (PRISM-CBT) improves outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults with spinal pain and fibromyalgia symptoms were randomized to PRISM-CBT (n=119), standard CBT (n=120), or usual care (UC; n=60). The primary outcome was the Fibromyalgia Impact Questionnaire-Revised (FIQR) global impact score at 8 weeks (0\u2013100; higher=worse). Secondary outcomes were pain interference and pain severity measured with the Brief Pain Inventory (BPI) (0\u201310; higher=worse).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The primary outcome showed no difference between PRISM-CBT and usual care at 8 weeks, with an adjusted between-group difference of 0.20 points (95%\u2009CI \u20134.81 to 5.20, p=0.939). Yet, by 12 months, PRISM-CBT demonstrated a 7.4-point greater improvement compared with usual care (95%\u2009CI 0.15 to 14.64, p=0.045) and a 4.8-point greater improvement versus CBT at 8 weeks (95%\u2009CI 0.00 to 9.57, p=0.050). PRISM-CBT produced the most consistent benefit in BPI pain interference. Compared with usual care, interference was lower by 0.88 points at both 8 weeks (95%\u2009CI 0.25 to 1.50, p=0.006) and 6 months (95%\u2009CI 0.23 to 1.54, p=0.009) and by 1.42 points at 12 months (95%\u2009CI 0.53 to 2.32, p=0.002). Compared with standard CBT, interference was lower at 8 weeks (0.98 points, 95%\u2009CI 0.38 to 1.57, p=0.001), 6 months (0.63 points, 95%\u2009CI 0.01 to 1.25, p=0.045), and 12 months (1.92 points, 95%\u2009CI 1.09 to 2.76, p&lt;0.001). BPI pain severity also favored PRISM-CBT, with greater improvements of 0.56 points vs usual care at 6 months (95%\u2009CI 0.03 to 1.08, p=0.039) and 0.86 points vs CBT at 12 months (95%\u2009CI 0.19 to 1.53, p=0.011).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This scalable, medical assistant-coached digital program shows promising benefits, including greater reductions in pain interference and a long-term improvement in global symptom burden, despite no difference at the primary endpoint.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-107389","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T14:40:17Z","timestamp":1772808017000},"page":"rapm-2025-107389","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Randomized controlled trial of medical 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