Internet interventions for chronic pain including headache: A systematic review

Monica Buhrman, Torsten Gordh, Gerhard Andersson, Monica Buhrman, Torsten Gordh, Gerhard Andersson

Abstract

Chronic pain is a major health problem and behavioral based treatments have been shown to be effective. However, the availability of these kinds of treatments is scarce and internet-based treatments have been shown to be promising in this area. The objective of the present systematic review is to evaluate internet-based interventions for persons with chronic pain. The specific aims are to do an updated review with a broad inclusion of different chronic pain diagnoses and to assess disability and pain and also measures of catastrophizing, depression and anxiety. A systematic search identified 891 studies and 22 trials were selected as eligible for review. Two of the selected trials included children/youth and five included individuals with chronic headache and/or migraine. The most frequently measured domain reflected in the primary outcomes was interference/disability, followed by catastrophizing. Result across the studies showed a number of beneficial effects. Twelve trials reported significant effects on disability/interference outcomes and pain intensity. Positive effects were also found on psychological variable such as catastrophizing, depression and anxiety. Several studies (n = 12) were assessed to have an unclear level of risk bias. The attrition levels ranged from 4% to 54% where the headache trials had the highest drop-out levels. However, findings suggest that internet-based treatments based on cognitive behavioural therapy (CBT) are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. Results showed that the effect size for interference/disability was Hedge's g = - 0.39, for pain intensity Hedge's g = - 0.33, for catastrophizing Hedge's g = - 0.49 and for mood variables (depression) Hedge's g = - 0.26.

Keywords: Chronic pain; Cognitive behavioral therapy; Headache; Internet; Pediatric pain; Self-help.

Figures

Fig. 1
Fig. 1
Flow chart.
Fig. 2
Fig. 2
Forest plot of studies comparing internet treatment against no treatment or treatment as usual control conditions for pain and headache using pain interference/disability ratings.
Fig. 3
Fig. 3
Forest plot of studies comparing internet treatment against no treatment or treatment as usual control conditions for pain and headache using pain severity ratings.
Fig. 4
Fig. 4
Forest plot of studies comparing internet treatment against no treatment or treatment as usual control conditions for pain and headache using catastrophizing ratings.
Fig. 5
Fig. 5
Forest plot of studies comparing internet treatment against no treatment or treatment as usual control conditions for pain and headache using depression ratings.

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Source: PubMed

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