Online Cognitive Behavioral Pain Management Course May Benefit Fibromyalgia

This is especially important given that patients with fibromyalgia have difficulty attending treatment sessions in person.

Research published in the journal PAIN shows that an internet-delivered cognitive behavioral pain management course significantly improves depression, pain, and fear of pain in patients with fibromyalgia.1

Blake F. Dear, PhD, from Macquarie University in Sydney, Australia and colleagues in the United States and Canada studied how the 5-lesson course, which they called the Pain Course, would benefit patients with fibromyalgia. The availability of such a tool is particularly important given that patients with fibromyalgia have known difficulties accessing or attending treatment sessions in person.

Sixty patients from 10 provinces in Canada were recruited and identified as meeting inclusion criteria. The researchers randomly assigned 30 patients to participate in the online pain management course and 30 patients to a control group who were added to a waiting list for the online course. The control group was given the opportunity to participate in the online course after the study was completed. The study is registered with the Current Controlled Trials Register (ISRCTN85116527).

The course consisted of 5 lessons delivered over 8 weeks, and participants were also contacted once a week either by phone or email by a doctorate-level clinical psychology student who provided support and acted as a guide throughout the course.

The Content of the Pain Course

Lesson 1 (1 week): Information was provided regarding the prevalence of chronic pain and symptoms of depression and anxiety, pain perception and the nervous system, the cognitive behavioral model, and the functional relationship between thought, physical symptoms, and behavioral symptoms.

Participants learned about symptom identification and formulation, and the course provided resources for dealing with the challenges associated with fibromyalgia, sleep management, measures to take in an emergency, and interactions with health professionals regarding treatments for chronic pain.

Lesson 2 (2 weeks):  Participants were taught principles of cognitive therapy and strategies for monitoring and challenging their thoughts to help manage pain, anxiety, and depression.

The course provided resources on structured problem-solving and belief-challenging.

Lesson 3 (1 week): Participants were exposed to the physical symptoms of anxiety, depression, and chronic pain.

Participants learned de-arousal strategies (eg, controlled breathing) and how to schedule pleasant activities. The course provided additional resources regarding attention management and chronic pain, chronic pain and panic attacks, and a list of 100 pleasant things to do.

Lesson 4 (2 weeks): Behavioral symptoms of anxiety, low mood, and chronic pain were detailed, and avoidance of physical activity due to fear of pain and the cycle of overdoing-underdoing physical activity were explained.

Participants learned how to pace themselves and gradually and safely increase physical activity. The course provided additional resources on assertive communication.

Lesson 5 (2 weeks): Participants were taught about lapses in pain, depression, and anxiety, and provided information about the signs of relapse, and the importance of goal-setting.

Improvements in Symptoms

The researchers assessed participants’ symptoms pre-treatment, post-treatment, and at 4-week follow-up. Completion rates (87%) and satisfaction ratings (86%) were high.

Improvements were significantly greater in the treatment group compared with the waiting-list group on measures of fibromyalgia (Cohen’s d =0.70; 18% reduction), depression (Cohen’s d =0.63-0.72; 20%-28% reduction), pain (Cohen’s d =0.87; 11% improvement), and fear of pain (Cohen’s d =1.61; 12% improvement). The researchers also found smaller improvements in generalized anxiety and physical health, which were maintained at 4-week follow-up.


“These findings highlight the significant potential of internet-delivered programs in the treatment of [fibromyalgia], especially as part of stepped-care models of service, and provide important information for program developers and funders,” the researchers wrote.

“With additional evidence, it is hoped that in the future, government-funded health care organizations would have an interest in providing the Pain Course or similar courses to fibromyalgia patients, thus improving access to treatment and alleviating the burden of chronic pain.”


  • The study had a relatively small sample size, which limited its statistical power
  • The majority of participants were women, and many were white, educated, and married
  • Participants volunteered for the study, which may mean they were inherently motivated to complete the treatment
  • The study relied on self-report of diagnosis

Future research with a larger sample size recruited from treatment centers with patients who have a confirmed diagnosis of fibromyalgia would be beneficial, as would collecting data on a broader range of outcomes (such as medication use), collecting data on measures of pain management skill use, and tracking engagement. It would also be useful to engage with the control group by weekly emails to see if outcomes can be attributed to attention or support.

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  1. Friesen LN, Hadjistavropoulos HD, Schneider LH, Alberts NM, Titov N, Dear BF. Examination of an internet-delivered cognitive behavioral pain management course for adults with fibromyalgia: a randomized controlled trial. PAIN. 2017;158(4):593-604. doi:10.1097/j.pain.0000000000000802