Remote, scalable cognitive behavioral therapy–based chronic pain programs are effective for treating individuals with high-impact chronic pain.

Importance Cognitive behavioral therapy (CBT) skills training interventions are recommended first-line nonpharmacologic treatment for chronic pain, yet they are not widely accessible.

Objective To examine effectiveness of remote, scalable CBT-based chronic pain (CBT-CP) treatments (telehealth and self-completed online) for individuals with high-impact chronic pain, compared with usual care.

Design, Setting, and Participants This comparative effectiveness, 3-group, phase 3 randomized clinical trial enrolled 2,331 eligible patients with high-impact chronic musculoskeletal pain from 4 geographically diverse health care systems in the US from January 2021 through February 2023. Follow-up concluded in April 2024.