Guided Internet-Based Psycho-Educational Intervention Using Cognitive Behavioral Therapy and Self-management for Individuals With Chronic Pain

A Feasibility Study

Jennifer Perry, PhD; Elizabeth G. VanDenKerkhof, PhD; Rosemary Wilson, PhD; Dean A. Tripp, PhD

Disclosures

Pain Manag Nurs. 2017;18(3):179-189. 

In This Article

Abstract and Introduction

Abstract

When considering barriers to chronic pain treatment, there is a need to deliver nonpharmacological therapies in a way that is accessible to all individuals who may benefit. To conduct feasibility testing using a guided, Internet-based intervention for individuals with chronic pain, a novel, Internet-based, chronic pain intervention (ICPI) was developed, using concepts proven effective in face-to-face interventions. This study was designed to assess usability of the ICPI and feasibility of conducting larger-scale research, and to collect preliminary data on effectiveness of the intervention. Data were collected at baseline, after each of the six intervention modules, and 12 weeks after intervention completion. Forty-one participants completed baseline questionnaires, and 15 completed the 12-week postintervention questionnaires. At baseline, all participants reported satisfaction with the structure of the intervention and ease of use. Internet-based platforms such as Facebook aided in accrual of participants, making further large-scale study of the ICPI feasible. There is preliminary evidence suggesting that the ICPI improves emotional function but not physical function, with a small but significant decrease in pain intensity and pain interference. Most participants felt they benefited at least minimally as a result of using the ICPI. The ICPI was well received by participants and demonstrated positive outcomes in this preliminary study. Further research with more participants is feasible and necessary to fully assess the effect of this intervention.

Introduction

Pain is a highly individualized, subjective experience influenced by personal and environmental factors (McCaffery & Beebe, 1989; Melzack & Wall, 1988). When pain becomes chronic, the resulting loss of productivity and eventual disability causes physical, emotional, and financial burden to sufferers and their social supports, as well as economic burden to the health care system and society (Boulanger, Clark, Squire, Cui, & Horbay, 2007; Choiniere et al., 2010; Kronborg, Handberg, & Axelson, 2009). In the United States, health care costs associated with pain top $500 billion per year, including costs of care, sick days, lost wages, and decreased productivity (American Academy of Pain Medicine, 2011; Gaskin & Richard, 2012). In Canada, the estimated annual cost of chronic pain is more than $55 billion (Canadian Pain Society, 2011; Guerriere et al., 2010).

More women than men report chronic pain, and the incidence and prevalence of chronic pain increases with age (McBeth & Jones, 2007; Moulin et al., 2002; Reitsma, Tranmer, Buchanan, & VanDenKerkhof, 2011, 2012; van Hecke, Torrance, & Smith, 2013). Evidence-based care for chronic pain includes pharmacological and nonpharmacological treatments targeting physical, psychological, and social domains (Jeffery, Butler, Stark, & Kane, 2011; Scascighini, Toma, Dober-Spielmann, & Sprott, 2008; Turk, Wilson, & Cahana, 2011). Many individuals do not have the opportunity to benefit from psychosocial interventions, however, due to geographical and financial barriers, demand exceeding availability of therapists, scheduling around family and work commitments, long wait lists, and the perceived stigma associated with accessing psychological support (Baer, Greist, & Marks, 2007; Bromberg et al., 2012; Jeffery et al., 2011; Lynch et al., 2008; Peng et al., 2007; Vogel, Wade, & Haake, 2006).

With an increasing number of people having access to the Internet, self-management websites and peer support via Internet forums are becoming more common (Ancker et al., 2009; Ybarra & Eaton, 2005). Use of computers to deliver interventions incorporating elements of cognitive behavioral therapy (CBT), self-management, and education has not been studied in depth in individuals with chronic pain, although this is an area that is currently receiving more interest.

While research has established the effectiveness of these therapies, delivered via traditional face-toface methods, for those with chronic pain (Broderick et al., 2014; Hoffman, Papas, Chatkoff, & Kerns, 2007; LeFort, Gray-Donald, Rowat, & Jeans, 1998; McCracken, MacKichan, & Eccleston, 2007; Nicholas et al., 2010; Reid et al., 2008; Sveinsdottir, Eriksen, & Reme, 2012), early studies documenting delivery of these therapies online involved individuals with depression, anxiety, other social and mood disorders (Andersson, 2006; Andersson, Bergstrom, Carlbring, & Lindefors, 2005; Andersson et al., 2005), and other chronic diseases (Ghahari, Packer, & Passmore, 2009; Kerr et al., 2010; Lorig, Ritter, Laurent, & Plant, 2006). The effect of an Internet-based chronic pain psycho-educational intervention that included selfmanagement and CBT had not been studied in depth prior to initiation of this project.

The purpose of this feasibility study was to test a guided Internet-based intervention developed for individuals with chronic pain, noting considerations in conducting a larger study, including cost, rate of recruitment, and attrition. Usability testing of the intervention was done to assess content and delivery method, time spent in the intervention, and overall satisfaction with the intervention. Finally, an exploratory assessment was completed to document the effect of the intervention on emotional functioning, physical functioning, pain severity, and pain interference and to elicit participant perception of the effectiveness of treatment in a small sample of participants.

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