Chronic pain: can treatment over the Internet help?

A short blog looking at Cochrane evidenceCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. on psychological therapies for adults with chronicA health condition marked by long duration, by frequent recurrence over a long time, and often by slowly progressing seriousness. For example, rheumatoid arthritis. pain.

Page last updated 27 June 2022

Using the Internet to deliver therapies has obvious benefits, including its reach free from geographical constraints, convenience and low costs. People living with chronic pain, lasting longer than three months, are in it for the long haul and should be able to access support to help them manage their condition away from expert healthcare centres.

A Cochrane Review Psychological therapies (Internet‐delivered) for the management of chronic pain in adults (February 2014) explored whether pain management therapies can be successfully delivered via the Internet to reduce pain and disability and improve anxiety and depression in adults with non-cancer chronic pain. The reviewers were also interested in whether people liked the programmes and whether they improved their quality of life. They found 15 randomizedRandomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group).   controlled trialsA trial in which a group (the ‘intervention group’) is given a intervention being tested (for example a drug, surgery, or exercise) is compared with a group which does not receive the intervention (the ‘control group’). (RCTs) with just over 2000 adults and compared those having internet-delivered therapies with those on waiting lists but, disappointingly, the key message is that “There is insufficient evidence to make conclusions regarding the efficacyThe extent to which an intervention (for example a drug, surgery, or exercise), produces a beneficial result under ideal conditions. of psychological therapies delivered via the Internet in participants with headache conditions”.

What about traditional methods of delivering these treatments?

This review complements another Cochrane ReviewCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research.: Psychological therapies for the management of chronic pain (excluding headache) in adults (updated August 2020). It has moderate- to low-certaintyThe certainty (or quality) of evidence is the extent to which we can be confident that what the research tells us about a particular treatment effect is likely to be accurate. Concerns about factors such as bias can reduce the certainty of the evidence. Evidence may be of high certainty; moderate certainty; low certainty or very-low certainty.  Cochrane has adopted the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) for assessing certainty (or quality) of evidence. Find out more here: https://training.cochrane.org/grade-approach evidence on cognitive behavioural therapy (CBT) from 59 studies with over 5000 people, showing that CBT probably has very small beneficial effects for reducing pain, disability, and distress compared with an active control (alternative interventions that engage people, such as exercise or education). Compared with ‘treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. as usual’, CBT probably has small benefits for reducing pain and distress at the end of treatment and may have small benefits for reducing disability. These effects were largely maintained at follow-up for the comparison with treatment as usual but not active control. There remains uncertainty about any harms that might be associated with treatment.

There is growing support for the effectivenessThe ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. of psychological therapies, and particularly CBT, for the management of chronic pain and its delivery via the Internet shows promise. Clearly there is more work to be done to increase our understanding of the usefulness of these therapies and means of delivery.

Links:

Eccleston C, Fisher E, Craig L, Duggan GB, Rosser BA, Keogh E. Psychological therapies (Internet-delivered) for the management of chronic pain in adults. Cochrane Database of Systematic ReviewsIn systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2014, Issue 2. Art. No.: CD010152. DOI: 10.1002/14651858.CD010152.pub2.

Williams  AC de C, Fisher  E, Hearn  L, Eccleston  C. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD007407. DOI: 10.1002/14651858.CD007407.pub4.