A pain management program delivered via the internet was found to lead to reductions in psychological distress, even among patients with severe pain and/or disability, according to the results of a study published in Pain Medicine.
Data for this study were sourced from 4 previous trials that recruited 1333 patients to participate in the Pain Course, an 8-week, internet-based class based on cognitive behavioral therapy with 5 lessons focused on improving symptoms of depression, anxiety, and disability. Patients were randomly assigned to engage in the Pain Course (n=912) or be placed on a waiting list (n=421). The waitlist cohort participated in the Pain Course following an 8-week waiting period. For this study, the primary outcome was change in symptoms of depression and anxiety from baseline. Clinically meaningful improvement was defined as an at least 30% improvement from baseline.
The mean age of study participants was 52.06 (standard deviation [SD], 14.11) years, 82.67% were women, 62.26% had muscular pain, 24.45% had fibromyalgia, 20.03% had osteoarthritis, 9.97% had headache or migraine, 7.87% had neuropathic conditions, 77.10% used medication for pain, 45.16% used medication for mental health, and average Wisconsin Brief Pain Questionnaire (WBPQ) pain intensity score was 5.80 (SD, 1.53).
At baseline, all pairwise comparisons between 2-item Patient Health Questionnaire (PHQ-2), 2-item General Anxiety Disorder (GAD-2), WBPQ, and Pain Disability Index (PDI) scores were correlated before (r range, 0.18-0.54) and after (r range, 0.26-0.52), controlling for age and gender, except for GAD-2 and WBPQ, which were no longer correlated after correction (r, 0.06).
In general, individuals who reported greater pain at baseline were more likely to report symptoms of depression (odds ratio [OR] range, 1.73-3.78) and anxiety (OR range, 1.64-2.58) compared with patients who reported low levels of pain at baseline. Similarly, patients with greater disability at baseline reported more symptoms of depression (OR range, 11.23-25.06) and anxiety (OR range, 3.03-6.77) compared with patients who reported low levels of disability at baseline.
Participants engaging in the Pain Course was found to experience a greater reduction in symptoms of depression compared with participants assigned to the waitlist (P <.001), but there was no effect on PHQ-2 scores on the basis of baseline WBPQ scores (P =.24). Similar trends were observed for the change in PHQ-2 scores on the basis of PDI scores at baseline. The change in GAD-2 scores followed the same pattern as PHQ-2 scores on the basis of WBPQ and PDI scores at baseline, in which there were significant effects following engagement in the Pain Course on anxiety (both P ≤.005) but no interaction effect for baseline severity (both P ≥.12).
Patients who achieved a clinically meaningful improvement in WBPQ scores were more likely to also achieve a clinically meaningful improvement in PHQ-2 (OR, 2.37; <.001) and GAD-2 (OR, 1.92; P <.001) scores, and those who achieved a clinically meaningful improvement in PDI were more likely to achieve improvement in PHQ-2 (OR, 2.56; P <.001) and GAD-2 (OR, 1.91; P <.01) scores.
This study found that a virtual pain management program significant improved symptoms of depression and anxiety, even among patients with severe pain or disability at baseline. The study authors conclude, “[T]he results of the current study are encouraging and illustrate the potential of internet-delivered [pain management programs] to address the mental health difficulties associated with chronic pain.
This article originally appeared on Clinical Pain Advisor
Bisby MA, Chandra SS, Dudeney J, Scott AJ, Titov N, Dear BF. Can internet-delivered pain management programs reduce psychological distress in chronic pain? Exploring relationships between anxiety and depression, pain intensity, and disability. Pain Med. Published online October 31, 222. doi:10.1093/pm/pnac158