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PainSci » bibliography » Dear et al 2015
Tags: neck, IT band pain, back pain, patellar pain, shin pain, plantar fasciitis, site news, education, head/neck, spine, knee, leg, limbs, pain problems, overuse injury, injury, running, exercise, self-treatment, treatment, tendinitis, arthritis, aging, patellofemoral joint, foot

Three pages on PainSci cite Dear 2015: 1. The Complete Guide to IT Band Syndrome2. The Complete Guide to Neck Pain & Cricks3. Complete Guide to Frozen Shoulder

PainSci commentary on Dear 2015: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Researchers tested a series of web-based pain management tutorials on a group of adults who had been suffering symptoms for more than six months. Regardless of how much contact the patients had with clinicians, they all experienced significant reductions in disability, anxiety, and average pain levels at the end of the eight-week experiment as well as three months down the line. The authors conclude, fairly I think, “While face-to-face pain management programs are important, many adults with chronic pain can benefit from programs delivered via the internet, and many of them do not need a lot of contact with a clinician in order to benefit.”

It’s hard to imagine study results any more in harmony with my business model. 😃 And so it’s important to note that I have scrutinized the methodology rather carefully to make sure I’m not just cherry-picking a conclusion I like. I have read the whole paper; it’s not a simple study, and as a non-statistician I cannot be absolutely certain there’s no glaring jiggery-pokery here. However, it is an essentially sound trial design, adequately powered and making meaningful comparisons and doing the math in the right way (“ANOVA”), avoiding one of the most notorious statistical errors in research (this alone puts it well ahead of the pack). Also, it’s hardly an extraordinary claim.

The full text is available for anyone with the skills to “check my work,” and of course I invite any criticism of my endorsement of this trial.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

The present study evaluated an internet-delivered pain management program, the Pain Course, when provided with different levels of clinician support. Participants (n = 490) were randomised to one of four groups: (1) Regular Contact (n = 143), (2) Optional Contact (n = 141), (3) No Contact (n = 131), and (4) a treatment-as-usual Waitlist-Control Group (n = 75). The treatment program was based on the principles of cognitive behaviour therapy (CBT) and comprised 5 internet-delivered lessons provided over 8 weeks. The three Treatment Groups reported significant improvements (between-groups Cohen's d; avg. reduction) in disability (ds ≥ 0.50; avg. reduction ≥ 18%), anxiety (ds ≥ .44; avg. reduction ≥ 32%), depression (ds ≥ 0.73; avg. reduction ≥ 36%) and average pain (ds ≥ 0.30; avg. reduction ≥ 12%) immediately post-treatment, which were sustained at or further improved to 3-month follow-up. High treatment completion rates and levels of satisfaction were reported and no marked or consistent differences were observed between the Treatment Groups. The mean clinician time per participant was 67.69 minutes (SD = 33.50), 12.85 minutes (SD = 24.61) and 5.44 minutes (SD = 12.38) for those receiving regular contact, the option of contact and no clinical contact, respectively. These results highlight the very significant public health potential of carefully designed and administered internet-delivered pain management programs and indicate that these programs can be successfully administered with several levels of clinical support.

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