Online tutorials for chronic pain reduced pain, anxiety, disability
Three pages on PainSci cite Dear 2015: 1. The Complete Guide to IT Band Syndrome 2. The Complete Guide to Neck Pain & Cricks 3. Complete Guide to Frozen Shoulder
PainSci commentary on Dear 2015: ?This page is one of thousands in the PainScience.com 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.
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.
related content
- “A randomized controlled trial of an educational intervention to prevent the chronic pain of whiplash associated disorders following rear-end motor vehicle collisions,” Brison et al, Spine, 2005.
- “A Cochrane review of patient education for neck pain,” Haines et al, The Spine Journal, 2009.
- “The therapy might work, but does it work in the manner you think it does?,” Lorimer Moseley, BodyInMind.org.
- “Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders,” Hurwitz et al, Spine (Phila Pa 1976), 2008.
- “Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials,” Ainpradub et al, Manual Therapy, 2015.
Specifically regarding Dear 2015:
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
- Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. Holden 2023 The Lancet Rheumatology.
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.