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.
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