The Pain Course : A randomised controlled trial of a clinician-guided Internet-delivered cognitive behaviour therapy program for managing chronic pain and emotional well-being

Abstract

The present study evaluated the efficacy of a clinician-guided Internet-delivered cognitive behaviour therapy (iCBT) program, the Pain Course, to reduce disability, anxiety, and depression associated with chronic pain. Sixty-three adults with chronic pain were randomised to either a Treatment Group or waitlist Control Group. Treatment consisted of 5 iCBT-based lessons, homework tasks, additional resources, weekly e-mail or telephone contact from a Clinical Psychologist, and automated e-mails. Twenty-nine of 31 Treatment Group participants completed the 5 lessons during the 8-week program, and posttreatment and 3-month follow-up data were collected from 30/31 and 29/31 participants, respectively. Treatment Group participants obtained significantly greater improvements than Control Group participants in levels of disability, anxiety, depression, and average pain levels at posttreatment. These improvements corresponded to small to large between-groups effect sizes (Cohen's d) at posttreatment for disability (d = .88), anxiety (d = .38), depression (d = .66), and average pain (d = .64), respectively. These outcomes were sustained at follow-up and participants rated the program as highly acceptable. Overall, the clinician spent a total mean time of 81.54 minutes (SD 30.91 minutes) contacting participants during the program. The results appear better than those reported in iCBT studies to date and provide support for the potential of clinician-guided iCBT in the treatment of disability, anxiety, and depression for people with chronic pain.

Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness

“…Several recent clinical trials implemented self-referral as a recruitment option. 20,28,43,44 In addition, the privacy and anonymity of Internet-delivered CBT may help patients who are introverted or depressed to be more open and receptive to treatment. 7 From a clinical efficiency perspective, Internetdelivered CBT offers substantial benefits.…”

Nursing Interventions in Patients with Chronic Pain and Depression: A Systematic Review

“…Australia (Dear et al, 2013;Nicholas et al, 2011;Chen & Francis, 2010) and the Netherlands (Samwel et al, 2009). In many of these studies, some of the participants were immigrants.…”

“…Of the 17 studies analysed, six were experimental studies -randomised control trials (Poleshuck et al, 2014;McCracken, Sato & Taylor, 2013;Tse, Vong & Tang, 2013;Dear et al, 2013;Frich et al, 2012;Chen & Francis, 2010) and eleven were pseudo-randomised trials (Fullen et al, 2013;Lattie et al, 2013;Nash et al, 2013;Taloyan, Alinaghizadeh & Löfvander, 2013;Tan et al, 2013;Nicholas et al, 2011;Bremander, Holmström & Bergman, 2010;Darchuk et al, 2010;Samwel et al, 2009;Unützer et al, 2008;Field et al, 2007). Based on our methodological quality instruments, we concluded that all the studies presented a high level of evidence.…”

Internet Cognitive–Behavioral Therapy for Depression in Older Adults With Knee Osteoarthritis: A Randomized Controlled Trial

“…Meta-analyses of iCBT for depression in the general population have demonstrated moderate to large effect sizes that provide evidence that iCBT is comparable to face-to-face CBT (23)(24)(25). Furthermore, specific benefits of iCBT for pain-related conditions have been reported (26,27). These factors suggest that iCBT may be particularly well-suited to older OA patients, particularly those with diminished mobility, and this form of intervention is aligned with the greater call for more accessible and flexible care pathways for arthritis (22).…”