Online tools can help manage pain

People with chronic pain may be able to use online tools to manage their symptoms, lessening the need for frequent doctor visits, an Australian study suggests.

Researchers tested a series of web-based pain management tutorials on a group of adults who had been suffering symptoms for more than six months. Regardless of how much contact the patients had with clinicians, they all experienced significant reductions in disability, anxiety and average pain levels at the end of the eight week experiment as well as three months down the line.

“While face-to-face pain management programs are important, many adults with chronic pain can benefit from programs delivered via the internet, and many of them do not need a lot of contact with a clinician in order to benefit,” lead study author Blake Dear, a psychology researcher at Macquarie University in New South Wales, said by email.

Dear and colleagues recruited patients online, then whittled the group down to 490 adults who had seen a doctor to assess their pain within the past three months, had no psychotic illnesses or severe depression and had regular access to a computer and the internet.

Participants were divided into one of three treatment groups to receive the web-based tutorials (bit.ly/1SQb0uh) along with regular contact with clinicians during the study, optional contact with providers or no contact. A fourth control group was told they were wait-listed for the online program and carried on their usual treatment with their doctors.

Patients in the regular contact group were required to have weekly phone or email conversations with clinicians trained in psychology, while people in the optional contact group were told this was available if they wanted to do it and the non-contact group was told clinicians were only available if they had technical difficulties or a mental health emergency.

The regular contact group had an average of 68 minutes of contact with clinicians over the eight-week treatment period, compared with 13 minutes for the optional contact group and about 5 minutes for the group with only emergency contact.

During that time, people in the treatment groups also had five web-based lessons that focused on pain management using cognitive behavior therapy techniques.

At the end of the eight weeks, patients in the treatment groups had average reductions of at least 18 percent in disability, 32 percent for anxiety, 36 percent for depression and 12 percent in typical pain levels.

These improvements were sustained or even improved after three months, and there were no significant differences between the intervention groups based on how much contact people had with clinicians.

In addition, people in the treatment groups had significantly greater reductions in disability, depression and anxiety than the patients wait-listed for the online courses.

One limitation of the study, the researchers acknowledge in the journal Pain, is that the study didn’t examine what therapies people received in the control group getting “treatment as usual,” which makes it impossible to know if people in that group would have recovered without any treatment.

Also, because all of the study participants asked to join a web-based symptom management program, it’s possible the results would be different among people not seeking out this type of care, the authors note.

It’s also possible that, given more than just the three months of follow up, more differences would emerge between the treatment groups, said Christine Rini, a behavioral health researcher at the University of North Carolina Chapel Hill.

“More broadly speaking, it may be that the most critical information that patients get from doctors working with an internet-based pain management program is communicated relatively quickly, and that additional contact does not really matter,” Rini, who wasn’t involved in the study, said by email.