An internet‐delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomized controlled trial

Abstract

Background Chronic pain is common after spinal cord injury (SCI) and dedicated SCI cognitive behavioural therapy pain management programmes (CBT‐PMPs) have a growing evidence base to support their uptake clinically. The development of internet‐delivered treatment options may overcome barriers to the access and uptake of centre‐based programmes. This study examines such an approach on quality of lie (QoL), pain, mood and sleep. Methods Adults with SCI pain (>3 months) were recruited and randomly assigned to the intervention or control group. The intervention comprised a six module CBT‐PMP delivered once weekly. A blinded assessor determined changes in self‐reported outcome measures post‐intervention and at 3 months. Linear mixed models and effect sizes based on changes between groups were reported. Significance was set p < 0.05. Results The recruitment rate was 32% (intervention n = 35, control n = 34), and the drop‐out rate at 3 months was 26%. On average, participants accessed three (SD 2.1) of six modules. While no difference in QoL was reported, a significant group*time interaction was found for NRS of current pain (χ2 = 8.22, p = 0.016), worst pain (χ2 = 11.20, p = 0.004), and Brief Pain Inventory (interference) (χ2 = 6.924, p = 0.031). Moderate to large effect sizes favouring the intervention were demonstrated at each time point for the pain metrics (Cohen's d: 0.38–0.84). At 3‐month follow‐up, 48% of the intervention group rated themselves improved or very much improved (p < 0.05). Conclusions This study demonstrates the potential of an internet‐delivered SCI specific CBT‐PMP in reporting significant statistical and clinical benefit in pain intensity and interference. Strategies to improve engagement are needed.

The Relationship Between Psychological and Physical Secondary Conditions and Family Caregiver Burden in Spinal Cord Injury: A Correlational Study

“…Empowerment of caregivers may reduce secondary conditions, and health care policies and rehabilitation programs must consider the need for a two-pronged approach addressing both complications and CB. The potential use of online programs for caregivers, similar to those used to improve self-management of UTIs 50 and chronic pain 51,52 in people with SCI, warrants exploration. The use of technology as applied in the prevention of PrIs 53 may be a resource to support families and to enhance communication with health care professionals.…”

Internet‐delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1‐year follow‐up

“…Long-term effects for Internet-ACT for diverse chronic pain remain unclear as follow-up assessments are limited to 6 months in all studies but one, where the follow-up period lasted 9 months and the prolonged effect of treatment varied between outcomes. Also, results are mixed or show no improvements for pain intensity, QoL, depression, anxiety, insomnia and values (Buhrman et al, 2013;Lin et al, 2017;Simpson et al, 2017;Trompetter et al, 2014), which leaves room for improvements, given the frequency of co-occurring problems in complex chronic pain (Burke et al, 2019;Dworkin et al, 2005;Scott et al, 2018).…”

Could neurosurgical patients benefit from psychotherapy? A few words on the use of cognitive-behavioural therapy in brain injured patients

“…W ostatnich latach zwraca się również uwagę na zastosowanie oddziaływań poznawczo-behawioralnych w terapii pacjentów leczonych metodami zabiegowymi, m.in. z powodu urazów czaszkowo-mózgowych, urazów kręgosłupa, chorób zwyrodnieniowych lub procesów rozrostowych w obrębie ośrodkowego układu nerwowego (OUN) (Anson i Ponsford, 2006;Burke et al, 2019;Ponsford et al, 2020;Szepietowska-Ilach, 2018;Zelencich et al, 2020). Ukazują się prace dotyczące związku CBT z szybkością powrotu do pełnej aktywności zawodowej, z radzeniem sobie z bólem i leczeniem przeciwbólowym (Mariano et al, 2018;Rolving et al, 2015Rolving et al, , 2016Rolving et al, , 2014 u pacjentów przechodzących operacje kręgosłupa.…”