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BACKGROUND: Chronic pain is a critical cause of personal suffering and societal concern. However, treatment options remain inadequate, and access to efficacious treatment is limited by geography, economics, and scale. Digital health interventions for chronic pain are easily scaled solutions to this problem, and autonomous conversational agents represent a new frontier in this treatment domain. Despite their potential impact, conversational agents powered by generative artificial intelligence (AI) have yet to be developed or examined for the treatment of chronic pain. OBJECTIVE: We aimed to develop and test Solace, a first-of-its-kind, expert-trained generative AI conversational agent designed to deliver support grounded in principles of evidence-based pain psychology. METHODS: We conducted an acceptability and usability study of Solace in a group of individuals with chronic pain. Participants (n=175) were recruited from Prolific, an online crowdsourcing platform, and interacted with Solace for at least 25 minutes. Self-report measures of system usability, treatment acceptability, and therapeutic alliance were completed after the interaction, and clinically relevant pain-related measures were completed before and after the interaction. RESULTS: Participants rated the usability of Solace to be excellent (System Usability Scale mean score 85.04, SD 13.6) and found it to be an acceptable intervention for chronic pain. The therapeutic alliance between participants and Solace was rated highly. Participants also demonstrated improvements in anxiety, pain interference, kinesiophobia, and pain resilience. Safety guardrails designed to identify and manage instances of suicidal ideation, injury, or requests for medication recommendations performed appropriately during the study. Solace is a usable and acceptable treatment for chronic pain that facilitates forming a strong therapeutic alliance with users. A single 30-minute conversation with Solace was also associated with improvements in several clinically relevant domains. CONCLUSIONS: Solace is a usable and acceptable expert-trained generative AI conversational agent for pain management. Randomized clinical trials are needed to evaluate the efficacy of Solace as a strategy for the treatment of chronic pain. TRIAL REGISTRATION: OSF Registries osf.io/9c7tv; https://osf.io/9c7tv.
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