Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial

Abstract

Background Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. Objective This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. Methods This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. Results In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (–1.43, 95% CI –2.49 to –0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. Conclusions The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. Trial Registration University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb

Leveraging Mobile Health to Manage Mental Health/Behavioral Health Disorders: Systematic Literature Review

“…A total of 11 themes and 2 individual observations were identified by the reviewers for a total of 48 occurrences in the literature, whereas 11 themes and 7 observations were noted for a total of 95 observations. In the 33 studies analyzed, 26 (79%) showed an improvement in symptoms of depression [25,26,[28][29][30][31][32][33][35][36][37][40][41][42][43][44][46][47][48][49][50][51][52][54][55][56], while 19 (58%) showed an improvement in anxiety [26][27][28][29][30][31][32][33]36,[38][39][40][44][45][46][53][54][55][56]. Only 11/33 (33%) reported that at least one symptom was not statistically significant when compared with results from the control group, but the improvement was still noted [25]…”

“…The following observations only occurred once in the literature: decrease in anger [26], decrease in decision conflict [30], decrease in decision regret [30], decreased digestive disturbance [26], decreased pain [26], increased medication adherence [41], and the intervention had no effect on self-efficacy [34]. [25,26,[28][29][30][31][32][33][35][36][37][40][41][42][43][44][46][47][48][49][50][51][52][54][55][56] 19 Reduced anxiety [26][27][28][29][30][31][32][33]36,[38][39][40][44][45][46][53]…”

“…When mHealth was used as the intervention, a reduction in both depression and anxiety was reported [26,27,29,30,32,33,35,36,38,39,41,43,[45][46][47][48][49][50]53,55,56]. The same can be said for telemedicine [25,28,31,40,44,51,52], and mostly for telephone intervention [34,37,42,54]. Only 1 of each telephone [34] intervention and telemonitoring [57] intervention had no effect on depression or anxiety.…”

“…Following the PRISMA checklist [20] and the Kruse protocol [21], we extracted the following data fields: participants, intervention, comparison with the control or other group, medical outcomes, and study design (PICOS; Table 1) as a way to summarize study characteristics, as required by PRISMA. Of the 33 studies analyzed over the 1-year period, 17 were from 2021 [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and 16 were from 2022 [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. All studies were RCTs involving adults, and 48% (16/33) involved an average age of 50 years or above.…”

“…Two studies reported no effects on mental health from the intervention [34,57]. [25,26,[28][29][30][31][32][33][35][36][37][40][41][42][43][44][46][47][48][49][50][51][52][54][55][56] 19 Reduced anxiety [26][27][28][29][30][31][32][33]36,[38][39][40][44][45][46][53][54][55][56] 7 Increased quality of life [36,41,44,49,…”