Guided internet-based cognitive-behavioral therapy for patients with chronic pain: A meta-analytic review

Jessy A Terpstra; Rosalie van der Vaart; Sylvia van Beugen; Roxy A van Eersel; Ioanna Gkika; Dorottya Erdős; Jana Schmidt; Caroline Radstake; Margreet Kloppenburg; Henriët van Middendorp; Andrea W M Evers

doi:10.1016/j.invent.2022.100587

Guided internet-based cognitive-behavioral therapy for patients with chronic pain: A meta-analytic review

Internet Interv. 2022 Nov 10:30:100587. doi: 10.1016/j.invent.2022.100587. eCollection 2022 Dec.

Authors

Affiliations

¹ Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands.
² Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands.
³ Leiden University Medical Center, Department of Psychiatry, B1-P, PO Box 9600, 2300 RC Leiden, the Netherlands.
⁴ Medical Delta, Huismansingel 4, 2629 JH Delft, the Netherlands.

Abstract

Background: Chronic pain has a large individual and societal burden. Previous reviews have shown that internet-based cognitive-behavioral therapy (iCBT) can support patients' pain coping. However, factors related to participant experience of iCBT and effective and safe iCBT delivery for chronic pain have not recently been summarized.

Objective: The aim of this review was to give an overview of the efficacy of guided iCBT for chronic pain on psychological, physical, and impact on daily life outcomes, including factors that inform optimal delivery.

Methods: Cochrane, Emcare, Web of Science, PubMed, PsycINFO, and Embase were systematically searched from inception to 11 February 2022. Randomized controlled trials on guided iCBTs for adults with chronic pain were included with a broad range of outcomes.

Results: The search yielded 7406 studies of which 33 studies were included totaling 5133 participants. ICBT was more effective than passive control conditions for psychological (ES = 0.34-0.47), physical (ES = 0.26-0.29), and impact outcomes (ES = 0.38-0.41). ICBT was more effective than active control conditions for distress (ES = 0.40), pain acceptance (ES = 0.15), and pain interference after outlier removal (ES = 0.30). Longer treatments were associated with larger effects for anxiety and quality of life than shorter treatments. Mode of therapist contact (synchronous, asynchronous or a mix of both) was not related to differences in effect sizes in most outcomes. However, studies with mixed and synchronous contact modes had higher effects on pain self-efficacy than studies with asynchronous contact modes. Treatment satisfaction was high and adverse events were minor. Dropout was related to time, health, technical issues, and lack of computer skills.

Conclusions: Guided iCBT is an effective and potentially safe treatment for chronic pain. Future research should more consistently report on iCBT safety and detail the effectiveness of individual treatment components to optimize iCBT in clinical practice.

Keywords: CBT; Chronic pain; Cognitive-behavioral therapy; Internet-based treatment; Meta-analysis.

Publication types

Review