Psychological therapies (internet delivered) for the management of chronic pain in adults

Abstract

Background Chronic pain (i.e. pain lasting longer than three months) is common. Psychological therapies (e.g. cognitive behavioural therapy) can help people to cope with pain, depression and disability that can occur with such pain. Treatments currently are delivered via hospital outpatient consultation (face-to-face) or more recently through the Internet. This review looks at the evidence for psychological therapies delivered via the Internet for adults with chronic pain. Objectives Our objective was to evaluate whether Internet-delivered psychological therapies improve pain symptoms, reduce disability, and improve depression and anxiety for adults with chronic pain. Secondary outcomes included satisfaction with treatment/treatment acceptability and quality of life. Search methods We searched CENTRAL (Cochrane Library), MEDLINE, EMBASE and PsycINFO from inception to November 2013 for randomised controlled trials (RCTs) investigating psychological therapies delivered via the Internet to adults with a chronic pain condition. Potential RCTs were also identified from reference lists of included studies and relevant review articles. In addition, RCTs were also searched for in trial registries. Selection criteria Peer-reviewed RCTs were identified and read in full for inclusion. We included studies if they used the Internet to deliver the primary therapy, contained sufficient psychotherapeutic content, and promoted self-management of chronic pain. Studies were excluded if the number of participants in any arm of the trial was less than 20 at the point of extraction. Data collection and analysis Fifteen studies met the inclusion criteria and data were extracted. Risk of bias assessments were conducted for all included studies. We categorised studies by condition (headache or non-headache conditions). Four primary outcomes; pain symptoms, disability, depression, and anxiety, and two secondary outcomes; satisfaction/acceptability and quality of life were extracted for each study immediately posttreatment and at follow-up (defined as 3 to 12 months post-treatment). 1 Psychological therapies (Internet-delivered) for the management of chronic pain in adults (Review)

Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

“…Teaching participants early-on techniques for pain flare management and/or providing an opportunity for ''remote participation'' (e.g., telemedicine) may help overcome these challenges, facilitating adherence. The evidence for efficacy of tele-delivered MM and CBT is promising 50 but has yet to be demonstrated among patients with opioid-treated chronic pain. Adherence may be further enhanced by extending this intervention to less affected patients, possibly preventing the need for opioid initiation or dose increase.…”

An Evaluation of the Effectiveness of the Modalities Used to Deliver Electronic Health Interventions for Chronic Pain: Systematic Review With Network Meta-Analysis (Preprint)

“…Primary Outcomes: Similar to previous research [44], pain severity was the primary outcome variable. For studies that did not report pain severity, the most relevant pain outcome was extracted (e.g., pain intensity, average pain, or typical pain level experienced.…”

Effectiveness of Serious Gaming During Multidisciplinary Rehabilitation for Patients with Complex Chronic Pain or Fatigue: A Natural Quasi-experiment (Preprint)

“…With small to medium sized effects, many patients will not benefit as intended [28]. The current state of evidence, provides little support as to identify those circumstances in which patients with CP or FSS will likely have the best experiences and outcomes from which (computer-based) bio-psychosocial or alternative treatments, and why [16,18,66,67]. In this regard, present findings point towards potential positive effects when (mindfulness-based) serious gaming is presented later on in a rehabilitation process to patients with chronic back pain and comorbid psychosocial problems.…”

“…A major challenge is to identify particularly (cost)effective therapeutic approaches [13], change techniques [14], and delivery modes (e.g. traditional or computer-based) for certain patients in various health care settings [15,16]. Herein, a contribution may be made by the pragmatic effectiveness evaluation of a serious gaming intervention (i.e.…”