Evidence and Dissemination

Empowered Relief® is a 1-session (2-hour) intervention that rapidly equips patients with effective pain relief skills. Developed at the Stanford University School of Medicine, Empowered Relief is delivered by certified clinicians of all types and has been adopted by leading healthcare organizations internationally.

Empowered Relief fills a crucial gap in pain care by offering patients quick access to skills-based pain treatment and reduced wait times. Because of its didactic format, large class sizes are possible (typical size 10-100 patients per class).

The Empowered Relief line of science includes published evidence in patients with chronic pain and patients undergoing different types of surgery. Across studies the evidence suggests multidimensional benefits across a range of symptoms suggest that it is an all-purpose intervention for people with acute and chronic pain. It may be delivered in-person or via Zoom, Teams, or other similar online platform.

Empowered Relief Details
• One 2-hour certified instructor led pain relief skills group intervention.
• Delivered with a standardized slide deck, instructor scripts, and patient-facing materials.
• Participants receive a pain survey (completed during the class), a personalized plan for Empowered Relief (completed during the class to tailor the information and skills use), and access to a free binaural relaxation “app” that they integrate into their personalized plan for ongoing and unlimited use.
• Participants leave the class with a self-created roadmap for relief.
• Many types of licensed clinicians may become certified
• Class delivery can occur online or in person.

Examples of Adoption
• Across 2,000 certified instructors, more than 15,000 patients have received Empowered Relief®.
• Available in 8 languages and in 31 countries.
• Offered in multiple VISNs and VA Medical Centers throughout the US Veteran Healthcare System for chronic pain and post-surgical pain relief.
• Adopted by the California Prison System (CA Department of Corrections and Rehabilitation) in primary care.
• Adopted by Multiple Federally Qualified Health Centers and clinical safety net centers in the U.S.
• Cleveland Clinic offers Empowered Relief® as standard care within Spine Surgery; meaning, everyone receives it, no screening applied with >1000 patients having received it prior to their spine surgery. Empowered Relief® is also paired with procedures such as low-dose ketamine infusions.
• Cleveland Clinic offers Empowered Relief® as standard care for chronic pain. Implementation article describing integration of into surgical and chronic pain care pathways https://www.frontiersin.org/articles/10.3389/fpain.2022.856252/full)
• Humana has adopted Empowered Relief® into its clinical portfolio.
• U.K. National Health Service offers Empowered Relief® to orthopedic surgery patients.
• Lehigh Valley Health Network, Cedars Sinai Healthcare (spine), Stanford Health Care, various Canadian pain clinics, the Canadian VA healthcare system, and the several U.S. VA medical centers have adopted Empowered Relief® as standard care for chronic pain.
• The University of Colorado (state primary care clinics) and Lehigh Valley Health Network (Pennsylvania) each have >30 certified Empowered Relief clinicians in their respective networks.
• Non-profit organizations such as Pain Canada and the Marfan Foundation offer online Empowered Relief nationally. Pain Canada delivers monthly classes with 50 Canadians per class.
• The Salem Virginia Veterans Medical Center offers Empowered Relief® as perioperative standard care for rural Veterans receiving various surgeries.
• Allegheny Health Network (Dr. Leah Flaherty) offers all patients Empowered Relief® at no cost. Clinicians are reporting a 35% reduction in depressive symptoms, 25% reduction in anxiety in patients 1-month after receiving Empowered Relief®. 87% of patients say they wish they had received Empowered Relief sooner in their care journey.
• Empowered Relief® includes an exclusive free online binaural website “app”. We receive 15,000 app website visitors each month.
• Pain Canada offers all Canadians national monthly Empowered Relief classes via their online platform.

COMPLETED RESEARCH
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Published Study 1: Chronic Low Back Pain  (N=263)
This NIH-funded randomized controlled trial revealed that single-session Empowered Relief® is clinically equivalent to 16 hours of cognitive behavioral therapy (gold-standard behavioral treatment for chronic pain) at 3 months and 6 months post-treatment for reducing pain-related distress, pain intensity, pain interference, pain bothersomeness, depression, anxiety, fatigue and sleep disturbance.Open access publication: 2021 publication in JAMA Network Open
International coverage, an NIH press release and coverage in the NYTimes

Published Study 2: Durability of Effects for Chronic Low Back Pain  (from study 1)
This study demonstrated durability of treatment effects of Empowered Relief® to 6 months post-treatment, continued non-inferiority to 8-session CBT and new superiority for anxiety, pain bothersomeness and pain catastrophizing.Open access publication (2024): Pain Reports.
NIH Press release (2/15/24): Benefits of a Single-Session Pain Skills Class in People With Chronic Low-Back Pain (govdelivery.com)

Published Study 3: Mixed-Type Chronic Pain  (N=105)
Study of online-delivered Empowered Relief® revealed multi-dimensional and superior symptom reduction for patients who receive Empowered Relief relative to those who receive standard care. Open access publication:  Ziadni et al. 2021 publication in JMIR.

Published Study 4: Breast Cancer Surgery  (N=63)
This randomized controlled trial tested a fully automated, on-demand version of Empowered Relief® (called My Surgical Success) in women undergoing breast cancer surgery at Stanford Hospital. Women who engaged with the brief digital treatment required about one week less opioids after breast cancer surgery relative to women who received the digital health education control intervention (no active pain relief skills).Open access publication:  2019 publication in Pain Medicine.

Published Study 5: Orthopedic Trauma Surgery  (N=84)
This randomized controlled trial to tested a fully automated, on-demand version of Empowered Relief® in orthopedic trauma surgery at Stanford Hospital, with the majority receiving their assigned treatment on an iPad in the hospital days 1-3 after surgery. Patients who received the on-demand version of Empowered Relief® (called My Surgical Success) reported less pain after surgery, and the analgesic benefits persisted to 3 months after surgery. Results suggest that Empowered Relief® clinically meaningful and sustained analgesia and enhances recovery after surgery.Open access publication (2022): Anesthesia and Analgesia.

Published Study 6.  Patient Reported Perceptions of Empowered Relief (N=82)
Post-treatment qualitative data from 82 individuals who received Empowered Relief as standard pain care. Results revealed 7 themes pertaining to patient descriptions of how the intervention helped them.Open access publication (2024):  PAIN Reports

Published Study 7.  Feasibility study of Empowered Relief in Patients Taking Daily Prescription Opioids (N=60)
Sixty-eight percent attended the telehealth class. Post-treatment reductions in pain catastrophizing at 3 and 6 months; pain intensity reduced at 3 months; trend toward decreasing daily opioid use (β=-9.31, P=.02), although this result did not survive correction for multiplicity.Open access publication (2025): JMIR Formative Research

Published Study 8. Marfan Syndrome and Marfan-like Diseases (N=92)
Marfan syndrome is a rare and often painful genetic disorder that affects connective tissue, and multiple organs and systems. We partnered with the Marfan Foundation to conduct a non-randomized feasibility and efficacy study of Empowered Relief delivered online to a single national cohort of individuals with Marfan and related diseases (simultaneous en masse online treatment). Participants (N=92) were: 69(75%) female; with a mean age of 48 years(SD=15); 78(85%) White. Attendance (80.7%) and treatment appraisal ratings (80%) supported feasibility for large group treatment. At 3 months, pain intensity and pain interference (primary outcomes) were significantly improved; as well as all secondary outcomes (e.g., pain catastrophizing, anxiety, and other variables) (p-values either <0.05 or <0.001). Open access publication (2026): Scientific Reports

Published Study 9. Nurse-delivered Empowered Relief. (N=150)
The American Society of Pain Management Nurses funded a national randomized controlled study of online nurse-delivered treatment in N=150 mixed-etiology chronic pain across the U.S. (PI: Watson). The team found multidimensional benefits for Empowered Relief that were superior to wait list control at 2 months post-treatment (endpoint) suggesting nurses are effective and the treatment may be scaled by nurses nationally. Open access publication (2025): Pain Management Nursing

Published Study 10.  Acute Low Back Pain in Canadian Primary Care. (N=63)
The Canadian Institute for Health Research funded a study of physical therapist-delivered Empowered Relief for acute low back pain in primary care clinics in Canada (PI: Carriere). Open access publication (2025): Journal of Pain Research

Study 11. Single-arm national pilot study of Empowered Relief in patients with chronic pain taking methadone or buprenorphine (N=69)
69 enrolled, 55 attended (80%). Repeated-measures ANOVAs and FDR-corrected post-hoc tests revealed significant reductions at 1-month post-ER class (primary endpoint) in pain intensity (d = 0.71), pain bothersomeness (d = 0.54), and pain interference (d = 0.61). At 3-month post-ER class, efficacy was maintained for pain intensity, pain bothersomeness, and pain interference (d = 0.28, 0.44, and 0.48, respectively). No significant time effects were observed for pain catastrophizing, sleep disturbance, physical function, fatigue, depression, anxiety, social isolation, and opioid craving.Open access (2026):  JMIR Formative Research

ACTIVE RESEARCH

Study 12. Prescription opioid misuse (N=231)
A NIDA funded a national randomized controlled trial is testing a fully automated version of Empowered Relief® that is tailored to patients with chronic pain and comorbid opioid misuse (MOBILE Relief study; PI: Darnall). The intervention is interactive and available on-demand thus scaling access to home-based care. Open access protocol publication: https://pubmed.ncbi.nlm.nih.gov/39122392/
Results manuscript in development.

Study 13. Spine Surgery in Military Members. (N=400)
In 2025, Vanderbilt University (PI: Archer) received a $4M DoD grant to study Empowered Relief as a rehabilitations strategy in military members following spine surgery.

Study 14. Military members with chronic musculoskeletal pain. (N=450)
The NIH/VA/DoD Collaboratory awarded the University of Utah (MPI: Fritz and Rhone) to study Empowered Relief in 400 military members with chronic musculoskeletal pain.

Study 15. National comparative effectiveness trial  (N= 1,650)
PCORI is funding a $13.4M national comparative effectiveness trial of online Empowered Relief vs. 8-session cognitive behavioral therapy in 1,650 adults with chronic pain of any type. (PI: Darnall). Status:  N=1500 enrolled.
https://www.pcori.org/research-results/2021/comparative-effectiveness-online-cognitive-behavioral-therapy-vs-online-single-session-pain-relief-skills-class-chronic-pain
Open access protocol publication (2026): https://pubmed.ncbi.nlm.nih.gov/41712512/

Additional active studies
Four additional NIH-funded randomized controlled trials are active and involve different principal investigators studying efficacy in different pain diagnoses and patient populations including patients with migraine (PI: Sturgeon), and those taking prescription opioids (PI: Ziadni). A Canadian Institutes for Health Research study (PI: Carriere) is examining Empowered Relief in Canadian Veterans with chronic pain and, separately, orthopedic surgery. A multi-site study of Spanish Empowered Relief® is underway at Stanford. An OHSU study is examining Empowered Relief following elective surgery, and multiple European studies are underway.

Tailorings
• Acute Pain (Surgery/Injury):  This version is widely used in the U.S., Canada, and the U.K. and has been the subject of research funded by the Canadian Institutes for Health Research (CIHR; PI Carriere). It is offered as standard care in Cleveland Clinic Spine Surgery.
• Military Members:  Military Empowered Relief is being studied in two DoD/NIH clinical trials, one in chronic pain and one in spine surgery. Military Empowered Relief is active in the Canadian Armed Forces.
• Veterans:  This version was created in concert with 13 U.S. and Canadian stakeholders. It is actively used in scores of VAMCs in the U.S. and Canada.
• Corrections Settings:  A tailored version of Empowered Relief is offered throughout the California Prison System primary care.
• Peripartum:  A peripartum version is available now and under study at Stanford.
• College/Teens: Available now.
• Youth: A tailored version for youth is developed and being researched. (PI: Simons)
• Parent/Caregivers:  In development at Stanford.
• Ukrainian translation:  Available in Spring 2026.

Billing‍
• Once certified, billing for service is at your discretion.
• In the U.S., billing codes are dependent on the clinician’s professional license and setting. However, 96165 (30minutes x 1 unit) and 96164 (15min x 6 units) are new codes that fit Empowered Relief across several professional disciplines.
• Psychologists in medical settings may also choose to explore H&B group codes.
• Many healthcare organizations offer Empowered Relief® at no cost to members/patients.
• Some clinicians charge patients a small fee to attend a class (e.g., $20).

Clinician Certification Workshops
• Offered online and quarterly. For information visit https://empoweredrelief.stanford.edu/
• Scholarships available.
• Zero ongoing fees. Once certified, clinicians acquire the entire Empowered Relief implementation toolkit, ongoing access to all resources, and free instructor support webinars every 2 months.