Online Cognitive Behavioral Therapy May Provide Pain Relief in Chemotherapy-Induced Peripheral Neuropathy

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The primary outcome of the PROSPECT trial was change in worst pain score.
The primary outcome of the PROSPECT trial was change in worst pain score.

Self-guided online cognitive behavioral pain management may result in improved “worst” pain but not “average” pain compared with usual care for the treatment of painful chemotherapy-induced peripheral neuropathy (CIPN), according to a recent study published in the Journal of Pain.

In this pilot clinical trial, 30 patients with CIPN were randomly assigned to participate in a self-guided cognitive behavioral pain management intervention (Proactive Self-Management Program for Effects of Cancer Treatment [PROSPECT]; ClinicalTrials.gov identifier: NCT02760654) for 8 weeks, and 30 patients were assigned to a waitlist control. Pain was evaluated with the numeric rating scale and other standardized measures for 7 days preintervention and postintervention.

The primary outcome was change in worst pain score. Secondary outcomes were change in average pain, change in nonpainful CIPN symptom severity, patient impression of change, and pain interference.

Compared with patients receiving usual care (n=19), patients who received the PROSPECT intervention (n=19) had improved worst pain scores (-0.94 vs 0; P =.046). In the intention-to-treat analysis (n=60), no significant difference in change in worst pain score was reported (P =.09). More patients in the PROSPECT group had a clinically significant reduction in worst pain intensity posttreatment compared with those receiving usual care (3 vs 1).

Mean changes in average pain (P =.18), pain interference (P =.98), nonpainful CIPN sensory symptoms (P =.41), and nonpainful CIPN motor symptoms (P =.95) were not significantly different between groups.

Participants reported moderate to high acceptability of and satisfaction with the PROSPECT website and reported the following positive aspects of the intervention: ease of use, ability to print off work sheets based on strategies that were learned, and access to pain symptoms management strategies. In contrast, the participants reported that information and strategies on management of nonpainful neuropathy symptoms were lacking. Use of PROSPECT decreased throughout the duration of the study, with its highest use at the beginning of the study.

The study authors concluded that the present study, “provides preliminary evidence supporting the efficacy of a self-guided cognitive behavioral pain management intervention for improving worst pain intensity in individuals with chronic painful CIPN.” They noted, however, that, “a larger study is needed to determine the true effect of PROSPECT on pain intensity and the secondary outcomes.”

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Reference

Knoerl R, Smith EML, Barton DL, et al. Self-guided online cognitive behavioral strategies for chemotherapy-induced peripheral neuropathy: a multicenter, pilot, randomized, wait-list controlled trial [published online December 8, 2017]. J Pain. doi: 10.1016/j.jpain.2017.11.009

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