An Internet-Based Intervention for Chronic Pain

Overview

Journal Dtsch Arztebl Int

Specialties General Medicine
Public Health

Date 2017 Oct 31

PMID 29082858

Citations 54

Authors

Jiaxi Lin

Sarah Paganini

Lasse Sander

Marianne Luking

David Daniel Ebert

Monica Buhrman

Gerhard Andersson

Harald Baumeister

Affiliations

Soon will be listed here.

Abstract

Background: Persons with chronic pain can be treated effectively with acceptance and commitment therapy (ACT). In this trial, we examined the effectiveness of guided and unguided ACT-based online treatment (ACTonPain) for chronic pain patients.

Methods: 302 individuals were randomly assigned to ACTonPain with or without guidance (n = 100/101) or to a waiting-list control group (n=101). The primary outcome was pain interference as measured by the Multidimensional Pain Inventory. The secondary outcomes were physical and emotional functioning, pain intensity, ACT process variables, quality of life, satisfaction with the intervention, adherence, and participants' rating of overall improvement. The online measurements were carried out before randomization (T0) and 9 weeks and 6 months after randomization (T1 and T2, respectively). Intention-to-treat (ITT) data analysis was supplemented with additional per-protocol analyses.

Results: The guided ACTonPain group showed significantly less pain interference than the control group in the ITT analysis (p = 0.01), with a moderate effect size at T1 and T2 (d = 0.58 respectively), corresponding to a number needed to treat (NNT) of 3.14 for both time points. Participants in the guided ACTonPain group also indicated higher pain acceptance (T1: d = 0.59; T2: d = 0.76). The unguided ACTonPain group showed to be significantly less depressed in comparison to the control group at at time T2 (d = 0.50). No significant differences with respect to effectiveness were found between the two ACTonPain groups (p>0.05).

Conclusion: The online intervention ACTonPain is effective for persons with chronic pain when the program is guided. Further research in a variety of settings of health care is needed in order to determine whether and how ACTonPain can be implemented.

Citing Articles

Back on track - digital health applications to treat back pain of rheumatic patients? Results of a qualitative interview study.

Boy K, May S, Labinsky H, Morf H, Heinze M, Leipe J Rheumatol Int. 2024; 44(12):2977-2987.

PMID: 39340666 PMC: 11618131. DOI: 10.1007/s00296-024-05726-x.

Acceptance and Commitment Therapy for Major Depressive Disorder: Navigating Depression Treatment in Traditional and Digital Settings with Insights from Current Research.

Apolinario-Hagen J, Druge M, Guthardt L, Haller E Adv Exp Med Biol. 2024; 1456:227-256.

PMID: 39261432 DOI: 10.1007/978-981-97-4402-2_12.

eLIFEwithIBD: study protocol for a randomized controlled trial of an online acceptance and commitment therapy and compassion-based intervention in inflammatory bowel disease.

Ferreira C, Pereira J, Matos-Pina I, Skvarc D, Galhardo A, Ferreira N Front Psychol. 2024; 15:1369577.

PMID: 39184944 PMC: 11342739. DOI: 10.3389/fpsyg.2024.1369577.

eHealth-Integrated Psychosocial and Physical Interventions for Chronic Pain in Older Adults: Scoping Review.

De Lucia A, Perlini C, Chiarotto A, Pachera S, Pasini I, Del Piccolo L J Med Internet Res. 2024; 26:e55366.

PMID: 39073865 PMC: 11319891. DOI: 10.2196/55366.

Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life.

Ye L, Li Y, Deng Q, Zhao X, Zhong L, Yang L PLoS One. 2024; 19(6):e0301226.

PMID: 38875241 PMC: 11178235. DOI: 10.1371/journal.pone.0301226.

References

Flor H, Rudy T, Birbaumer N, Streit B, Schugens M . [The applicability of the West Haven-Yale multidimensional pain inventory in German-speaking countries. Data on the reliability and validity of the MPI-D.]. Schmerz. 1990; 4(2):82-7. DOI: 10.1007/BF02527839. View

Radbruch L, Loick G, Kiencke P, Lindena G, Sabatowski R, Grond S . Validation of the German version of the Brief Pain Inventory. J Pain Symptom Manage. 1999; 18(3):180-7. DOI: 10.1016/s0885-3924(99)00064-0. View

Andersson G . Internet-Delivered Psychological Treatments. Annu Rev Clin Psychol. 2015; 12:157-79. DOI: 10.1146/annurev-clinpsy-021815-093006. View

Hauser W, Bock F, Engeser P, Tolle T, Willweber-Strumpfe A, Petzke F . Long-term opioid use in non-cancer pain. Dtsch Arztebl Int. 2014; 111(43):732-40. PMC: 4238316. DOI: 10.3238/arztebl.2014.0732. View

Dworkin R, Turk D, Wyrwich K, Beaton D, Cleeland C, Farrar J . Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2007; 9(2):105-21. DOI: 10.1016/j.jpain.2007.09.005. View

Dear B, Gandy M, Karin E, Staples L, Johnston L, Fogliati V . The Pain Course: a randomised controlled trial examining an internet-delivered pain management program when provided with different levels of clinician support. Pain. 2015; 156(10):1920-1935. PMC: 4770347. DOI: 10.1097/j.pain.0000000000000251. View

Cavanagh K . Geographic inequity in the availability of cognitive behavioural therapy in England and Wales: a 10-year update. Behav Cogn Psychother. 2013; 42(4):497-501. DOI: 10.1017/S1352465813000568. View

Eccleston C, Fisher E, Craig L, Duggan G, Rosser B, Keogh E . Psychological therapies (Internet-delivered) for the management of chronic pain in adults. Cochrane Database Syst Rev. 2014; (2):CD010152. PMC: 6685592. DOI: 10.1002/14651858.CD010152.pub2. View

Lowe B, Decker O, Muller S, Brahler E, Schellberg D, Herzog W . Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008; 46(3):266-74. DOI: 10.1097/MLR.0b013e318160d093. View

10.

Wicksell R, Olsson G, Melin L . The Chronic Pain Acceptance Questionnaire (CPAQ)-further validation including a confirmatory factor analysis and a comparison with the Tampa Scale of Kinesiophobia. Eur J Pain. 2008; 13(7):760-8. DOI: 10.1016/j.ejpain.2008.09.003. View

11.

Wetherell J, Afari N, Rutledge T, Sorrell J, Stoddard J, Petkus A . A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain. 2011; 152(9):2098-2107. DOI: 10.1016/j.pain.2011.05.016. View

12.

Luo X, George M, Kakouras I, Edwards C, Pietrobon R, Richardson W . Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine (Phila Pa 1976). 2003; 28(15):1739-45. DOI: 10.1097/01.BRS.0000083169.58671.96. View

13.

Baumeister H, Knecht A, Hutter N . Direct and indirect costs in persons with chronic back pain and comorbid mental disorders--a systematic review. J Psychosom Res. 2012; 73(2):79-85. DOI: 10.1016/j.jpsychores.2012.05.008. View

14.

Veehof M, Trompetter H, Bohlmeijer E, Schreurs K . Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn Behav Ther. 2016; 45(1):5-31. DOI: 10.1080/16506073.2015.1098724. View

15.

Bond F, Hayes S, Baer R, Carpenter K, Guenole N, Orcutt H . Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther. 2011; 42(4):676-88. DOI: 10.1016/j.beth.2011.03.007. View

16.

Webb T, Joseph J, Yardley L, Michie S . Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010; 12(1):e4. PMC: 2836773. DOI: 10.2196/jmir.1376. View

17.

Ebert D, Lehr D, Smit F, Zarski A, Riper H, Heber E . Efficacy and cost-effectiveness of minimal guided and unguided internet-based mobile supported stress-management in employees with occupational stress: a three-armed randomised controlled trial. BMC Public Health. 2014; 14:807. PMC: 4153891. DOI: 10.1186/1471-2458-14-807. View

18.

Buhrman M, Skoglund A, Husell J, Bergstrom K, Gordh T, Hursti T . Guided internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial. Behav Res Ther. 2013; 51(6):307-15. DOI: 10.1016/j.brat.2013.02.010. View

19.

Barak A, Klein B, Proudfoot J . Defining internet-supported therapeutic interventions. Ann Behav Med. 2009; 38(1):4-17. DOI: 10.1007/s12160-009-9130-7. View

20.

Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D . Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2005; 10(4):287-333. DOI: 10.1016/j.ejpain.2005.06.009. View