Can Internet-Delivered Pain Management Programs Reduce Psychological Distress in Chronic Pain? Exploring Relationships Between Anxiety and Depression, Pain Intensity, and Disability

Abstract

Adults with chronic pain who also report high pain intensity and disability are more likely to experience depression and anxiety symptoms. The current study examined changes in anxiety and depression symptoms after an internet-delivered pain management program based on baseline pain intensity and disability severity categories. In a secondary analysis of data from four randomised controlled trials (n = 1333), greater pain intensity and disability were associated with increased odds of elevated anxiety or depression symptoms at baseline. Treatment led to greater reductions in anxiety and depression symptoms compared to a waitlist control, and these improvements occurred irrespective of baseline pain intensity or disability severity. Those individuals who reported ≥ 30% improvements in pain intensity or disability at post-treatment were more likely to also report ≥ 30% improvements in psychological symptoms. Importantly, most participants who achieved ≥ 30% improvements in depression and anxiety had not experienced such improvements in pain intensity or disability. These findings suggest that emerging internet-delivered pain management programs can lead to reductions in psychological distress even when pain intensity and disability are severe or do not improve with treatment. This indicates the value of such treatments in treating distress and improving mental health in people with chronic pain.

Chronic Pain and Comorbid Depression: A Narrative Review

“…In a paper entitled "Can Internetdelivered pain management programs decrease psychological distress in chronic pain?" (N= 1333), greater pain intensity was associated with increased odds of elevated anxiety or depression symptoms at baseline [28]. Internet intervention led to greater reductions in anxiety and depression, and a 30% decrease in pain intensity led to a 30% improvement in psychological symptoms.…”

A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress

“…One of the most widely accepted defines this psychological construct as "state of emotional suffering characterized by the undifferentiated combinations of symptoms of depression (e.g., lost interest, sadness, hopelessness) and anxiety (e.g., restlessness, feeling tense) which are sometimes accompanied by somatic symptoms (e.g., insomnia, headaches, lack of energy)" (Drapeau et al, 2012, p. 125). Generally, psychological distress refers to a range of unpleasant emotional and mental experiences that can impact a person's well-being and ability to function (Bisby et al, 2022;Gasslander et al, 2022). It is also considered a dimensional construct that has been truncated in most studies to employ it as a categorical construct to establish when it is or is not "clinically relevant, " with relevant meaning that scores on psychopathological measures exceed specific cut-off points.…”