Internet-delivered cognitive and behavioural based interventions for adults with chronic pain: a systematic review and meta-analysis of randomized controlled trials. Issue 10 (7th October 2022)

• Record Type: Journal Article
• Authors: Gandy, Milena; Pang, Sharon T.Y.; Scott, Amelia J.; Heriseanu, Andreea I.; Bisby, Madelyne A.; Dudeney, Joanne; Karin, Eyal; Titov, Nickolai; Dear, Blake F.
• Is Part Of: Pain. Volume 163:Issue 10(2022)
• Page Start: e1041
• Page End: e1053
• Publication Date: 2022-10-07
• Subjects: Telehealth -- e-therapy -- Psychotherapy -- Online -- Pain management -- Disability -- Depression -- Anxiety -- Self-efficacy -- Catastrophizing -- Clinician guided -- iCBT -- Acceptance and commitment therapy; Pain -- Periodicals; Douleur -- Périodiques; Anesthésie -- Périodiques; Pain; Electronic journals; Periodicals; Electronic journals; 616.0472
• DOI: 10.1097/j.pain.0000000000002606
• Languages: English
• ISSNs: 0304-3959

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Abstract: This study examined the efficacy of internet-delivered cognitive and behavioural interventions for adults with chronic pain AND explored the role of clinical and study characteristics as moderators of treatment effects. PubMed, Embase, PsycINFO, CENTRAL and CINAHL were searched to identify randomized controlled trials published up to October 2021. A meta-analysis of 36 studies (5778 participants) was conducted, which found small effect sizes for interference/disability (Hedges' g = 0.28; 95% confidence interval [CI] 0.21-0.35), depression ( g = 0.43; 95% CI 0.33-0.54), anxiety ( g = 0.32; 95% CI 0.24-0.40), pain intensity ( g = 0.27; 95% CI 0.21-0.33), self-efficacy ( g = 0.39; 95% CI 0.27-0.52) and pain catastrophizing ( g = 0.31; 95% CI 0.22-0.39). Moderator analyses found that interventions which involved clinician guidance had significantly greater effect sizes for interference/disability ( g = 0.38), anxiety ( g = 0.39), and pain intensity ( g = 0.33) compared with those without ( g = 0.16, g = 0.18, and g = 0.20, respectively). Studies using an inactive control had greater effects for depression ( g = 0.46) compared with active control trials ( g = 0.22). No differences were found between treatments based on traditional cognitive behaviour therapy vs acceptance and commitment therapy. Sample size, study year, and overall risk of bias (Cochrane rating) did not consistently moderate treatment effects. Overall, the results support the use of internet-delivered cognitive and behavioural interventions as efficacious and suggest guided interventions are associated with greater clinical gains for several key pain management outcomes.