General Psychiatry

Chronic Pancreatitis Pain Management Via Internet-Based Cognitive Behavioral Therapy

Bradley van Paridon
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Pancreatitis. Coloured axial computed tomography (CT) scan through the abdomen of a 54-year-old man with pancreatitis, inflammation of the pancreas. The pancreas is at upper centre, and has been highlighted (black) using an intravenous iodine injection as a contrast medium. The image shows pancreatic atrophy due to numerous lesions in a case of chronic calcifying pancreatitis.
Investigators conducted a pilot feasibility study on the effects of an internet-based CBT program on symptoms of pain in patients with chronic pancreatitis.

Preliminary results demonstrating the feasibility, acceptability, and efficacy of cognitive behavioral therapy (CBT) for pain self-management among patients with chronic pancreatitis were published in Clinical and Translational Gastroenterology.

Adult patients with suspected or confirmed chronic pancreatitis (N=30) were randomized to the control group or to complete an internet-based CBT course consisting of 5 lessons delivered over 8 weeks (ClinicalTrials.gov Identifier: NCT03322644). Researchers evaluated pain interference, pain intensity, and health-related quality of life pre and post-treatment and at 3-months follow-up.

Participants had a median age of 49.8 years (SD, 12.5 years), 80% were women, and 18 participants had confirmed chronic pancreatitis while, 12 were suspected cases. Overall, at pretreatment, 60% of participants were taking opioids, 20% reported alcohol use, and 47% had moderate to severe symptoms of anxiety, depression, and/or sleep disturbance.

In the CBT group, 100% of participants completed at least 1 lesson, 64% (9/14 participants) completed all 5 lessons, and 57% (8/14 participants) completed at least 6 of 8 coaching calls via telephone, which averaged 10 minutes.

The majority (80%) of CBT participants rated the intervention at 27 or higher on the Treatment Evaluation Inventory form (mean, 29.7; SD, 2.5). The change in pain interference on the Brief Pain Inventory form from pre to immediately post-treatment was similar for both groups, but at follow-up the CBT group reported significantly greater reductions in pain (P =.04).

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CBT participants also reported greater reductions in pain intensity from pretreatment to post-treatment (P =.09) and to follow-up (P =.07), as well as greater improvement in health-related quality of life scores from pre to post-treatment (P =.08). The proportion of treatment responders (those achieving a greater than 30% improvement in pain interference or intensity) was significantly greater in the CBT group as well (P =.04).

Study limitations include the lack of a measure of treatment expectancy, or an attention-control comparator. Additionally, the study sample size was small and consisted of predominantly White, college educated women.

Researchers concluded that while internet-delivered CBT shows promise, “Future research to extend these findings in a larger and more definitive [randomized controlled trial] using an attention-control group are needed.”

Reference

Palermo TM, Law EF, Topazian MD, et al. Internet cognitive-behavioral therapy for painful chronic pancreatitis: a pilot feasibility randomized controlled trial. Clin Transl Gastroenterol. 2021;12(6):e00373. doi:10.14309/ctg.0000000000000373

This article originally appeared on Gastroenterology Advisor