An Internet-based Cognitive Behavioral Program, With Telephone Support, Improves Pain, Disability and Emotional Wellbeing in Adults with Chronic Pain: Randomized Controlled Trial of the Pain Course With 2-year Follow-up.

OBJECTIVES

To evaluate the efficacy of the online cognitive behavioral therapy (CBT)-based Pain Course on levels of pain, disability, and psychological wellbeing in adults with chronic pain living in Ireland, with two-year follow-up.

METHODS

133 people were randomly assigned (ISRCTN11292570) to either the Pain Course (n=66) comprising five lessons delivered over eight weeks with clinician support, or to delayed access with usual care in the interim (n=67). The primary outcome was pain-related disability while secondary outcomes were depression, anxiety and average pain, and tertiary outcomes were pain self-efficacy, fear of movement, and pain acceptance. Outcomes were collected at post-treatment, 3-month follow-up (n=55 [83% retention]) and 2-year follow-up (n=29 [44% retention]).

RESULTS

Course completion rate was 80%. Improvements were significantly greater for Treatment Group participants compared to Control Group on measures of disability, anxiety, depression, and average pain at post-treatment (Cohen's d =.48-1.00). Improvements in outcomes were in the range 12%-44% and benefits were maintained or improved at 3 month follow-up. All tertiary outcomes also improved in the treatment group. There was substantial attrition at 2-year follow-up, but for those who responded, treatment effects were largely maintained. High treatment satisfaction ratings were expressed by over 80% of participants. Average clinician contact, per participant, was 81.06 minutes.

DISCUSSION: The findings of the current study in an Irish sample corroborate those of previous Pain Course efficacy trials and highlight the potential benefits of internet-based interventions for adults with chronic pain, with treatment effects maintained for up to 2 years in those who responded.