A recent comparative effectiveness study found that individuals with chronic pain who received cognitive behavioral therapy augmented by artificial intelligence and digital feedback (AI-CBT-CP) were more likely to achieve clinically meaningful gains in pain-related disability and pain intensity at the six-month mark compared to those assigned to conventional telephone-based CBT-CP. Questions remain regarding how AI and digital approaches affect socially disadvantaged populations. This analysis explored differences in full treatment session completion rates and clinically significant improvements in pain-related disability and intensity across patient subgroups defined by social determinants of health (SDOH). Social determinants of health factors examined included age, race, gender, education level, income, marital status, geographic accessibility, and clinical severity. Multivariate models incorporating interaction terms evaluated whether these SDOH factors moderated treatment engagement and response to AI-CBT-CP relative to standard telephone CBT-CP. Approximately half of the participants (52.9%) were aged 65 years or older, 10.8% were women, and 19.1% identified as Black or as having multiple racial backgrounds. AI-CBT-CP was associated with relatively strong session completion rates across all SDOH subgroups, with no subgroup showing higher completion rates under standard telephone CBT-CP. The superior effects of AI-CBT-CP on pain-related disability and intensity were largely consistent across SDOH categories. AI-CBT-CP produced a stronger relative benefit for pain-related disability among patients under 65 years old (P = .002). In no SDOH subgroup did standard telephone CBT-CP outperform AI-CBT-CP on either disability or pain intensity outcomes. The results indicate that patients facing SDOH-related disadvantages do not experience reduced engagement or inferior outcomes with AI- and digitally supported CBT-CP compared to traditional telephone CBT-CP. AI-CBT-CP appears capable of addressing access barriers without increasing disparities, offering particular value to underserved groups living with chronic pain.
