The effectiveness of various computer-based interventions for patients with chronic pain or functional somatic syndromes: A systematic review and meta-analysis

Abstract

Computer-based interventions target improvement of physical and emotional functioning in patients with chronic pain and functional somatic syndromes. However, it is unclear to what extent which interventions work and for whom. This systematic review and meta-analysis (registered at PROSPERO, 2016: CRD42016050839) assesses efficacy relative to passive and active control conditions, and explores patient and intervention factors. Controlled studies were identified from MEDLINE, EMBASE, PsychInfo, Web of Science, and Cochrane Library. Pooled standardized mean differences by comparison type, and somatic symptom, health-related quality of life, functional interference, catastrophizing, and depression outcomes were calculated at post-treatment and at 6 or more months follow-up. Risk of bias was assessed. Sub-group analyses were performed by patient and intervention characteristics when heterogeneous outcomes were observed. Maximally, 30 out of 46 eligible studies and 3,387 participants were included per meta-analysis. Mostly, internet-based cognitive behavioral therapies were identified. Significantly higher patient reported outcomes were found in comparisons with passive control groups (standardized mean differences ranged between -.41 and -.18), but not in comparisons with active control groups (SMD = -.26 - -.14). For some outcomes, significant heterogeneity related to patient and intervention characteristics. To conclude, there is a minority of good quality evidence for small positive average effects of computer-based (cognitive) behavior change interventions, similar to traditional modes. These effects may be sustainable. Indications were found as of which interventions work better or more consistently across outcomes for which patients. Future process analyses are recommended in the aim of better understanding individual chances of clinically relevant outcomes.

Pilot Trial of the Reboot Online Program: An Internet-Delivered, Multidisciplinary Pain Management Program for Chronic Pain

“…These findings were evident immediately after completion of the program and were largely retained at three months. In comparison to the typically small to moderate effect sizes previously reported in the literature [ 14 , 15 ], the current results demonstrate large effect sizes on the majority of measures posttreatment (range: 0.81–1.46) and moderate effect sizes on the remaining (range: 0.54–0.66). Even compared to more efficacious Internet-based pain programs, the current results are at least comparable and on some measures more favourable [ 12 ].…”

“…In recent years, a strong evidence base has developed for the efficacy of Internet-based psychological treatments, especially those based on cognitive behavioural therapy (CBT) principles, to treat a wide range of mental health conditions including depression and anxiety disorders [ 7 – 9 ]. Moreover, several Internet-based treatment programs for chronic pain have been developed, with burgeoning evidence indicating efficacy in reducing disability, mood disturbance, and improving perceived self-efficacy [ 10 – 14 ]. However, the efficacy of these programs is variable due to methodological inconsistencies in the literature, including different outcome measures, key program content, types of control groups used, and clinician involvement [ 15 ].…”

“…Another systematic review reported effect sizes ranging from small to large for pain intensity measures (0.20–0.85); however, most were in the small to moderate range with only one (out of 19) reporting a large effect size [ 15 ]. A consequent systematic review duplicated the small to moderate effect sizes for pain intensity scores (−0.35 to −0.16), measures of catastrophising (range −0.32 to −0.26), depression (range −0.18 to −0.14), and functional interference (−0.35 to −0.16; [ 14 ]). Therefore, given the typically small to moderate effect sizes reported of Internet-based pain management programs, it is warranted to explore the viability of developing a novel program to improve treatment efficacy.…”

Serious Gaming During Multidisciplinary Rehabilitation for Patients With Chronic Pain or Fatigue Symptoms: Mixed Methods Design of a Realist Process Evaluation

“…-Tasks within the game 'LAKA' could be interpreted from the behavioral change taxonomy version 1 [13]. In this regard, serious gaming provides vicarious learning opportunities that are not present in other (computer-based) interventions for the target group [14].…”

Patients’ experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study

“…Internet-delivered treatments for chronic pain may reduce pain, depression, anxiety and disability among adults [24] and children [27]. IACT specifically may effect pain acceptance, anxiety, depression, catastrophizing, pain interference, affective distress, pain intensity, pain disability, and fear-avoidance, with effect sizes varying from small to large [45]. However, IACT remains a relatively under-researched area.…”