Online pain management programs are associated with improvements in pain and depression outcomes among patients with fibromyalgia. These are the findings from a systematic review and meta-analysis published in the journal Pain Practice.
In chronic pain, face-to-face comprehensive biopsychosocial pain management programs have been associated with improved pain intensity, attitudes, depression, and functional disability. Since the COVID-19 pandemic, many of these interventions have transitioned to online pain management.
For the study, researchers sought to evaluate whether online pain management programs may be effective in the setting of chronic pain. The researchers, from The University of Sydney in Australia, searched publication databases through August 2021 for studies of online pain education for patients with non-cancer chronic pain conditions.
A total of 18 articles were included in this analysis. The studies were published between 2008 and 2021 and conducted in the United States (n=8), Canada (n=5), the Netherlands (n=3), Sweden (n=1), and Brazil (n=1).
The studies used a web-based intervention (n=16) or a mobile phone-based intervention (n=2). A minority of the interventions were entirely self-completed (n=5). The control condition was a non-educative control group (eg, usual care or standard care) in 10 studies, whereas the other studies used a reference book or publicly available information online as control.
The patients were mostly women (83%) and in the studies, the researchers recruited patients with fibromyalgia (n=7), juvenile idiopathic arthritis (JIA; n=5), rheumatoid arthritis (RA; n=3), systemic lupus erythematosus (n=1), systemic sclerosis (n=1), and fibromyalgia or RA (n=1).
Overall, online pain management programs were associated with improved pain intensity compared with control (standardized mean difference [SMD], -0.30; 95% CI, -0.50 to -0.10; I2, 68%; P =.004). However, this trend was driven by patients with fibromyalgia (SMD, -0.51; 95% CI, -0.82 to -0.20; I2, 55%; P =.001) whereas the interventions were not preferred over control for improving pain intensity among patients with:
- JIA (SMD, -0.17; 95% CI, -0.53 to 0.18; I2, 68%; P =.34),
- RA (SMD, -0.22; 95% CI, -0.48 to 0.04; I2, 0%; P =.10), or
- systemic sclerosis (SMD, -0.00; 95% CI, -0.25 to 0.25; P =.97).
For the outcome of health-related quality of life, online pain management was preferred over control overall (SMD, 0.41; 95% CI, 0.08-0.31; I2, 85%; P =.02), however, as with the pain intensity outcome, this trend was driven by patients with fibromyalgia (SMD, 0.71; 95% CI, 0.16-1.26; I2, 74%; P =.01) and was not significant among other groups.
There was also evidence to support the intervention over control among patients with fibromyalgia for the outcome of depression (SMD, -0.55; 95% CI, -0.90 to -0.21; I2, 64%; P =.002).
Stratified by intervention components, pain intensity was improved with cognitive behavioral therapy with disease education and/or pain neuroscience education (SMD, -0.34; 95% CI, -0.67 to -0.01; P =.04) but not other intervention components.
The researchers noted that guided online pain management programs may be more effective than self-completed interventions, as 3 of the 4 studies that reported improved pain intensity were guided.
“[O]nline pain management is effective in reducing pain intensity, improving health-related quality of life, and reducing depression particularly in those with fibromyalgia,” the researchers concluded.
Chew MT, Chan C, Kobayashi S, Cheng HY, Wong TM, Nicholson LL. Online pain management programs for chronic, widespread musculoskeletal conditions: A systematic review with meta-analysis. Pain Pract. Published online April 13, 2023. doi:10.1111/papr.13227