Can pain be managed through the Internet? A systematic review of randomized controlled trials

Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Canada.
Pain (Impact Factor: 5.21). 05/2011; 152(8):1740-50. DOI: 10.1016/j.pain.2011.02.012
Source: PubMed


Given the increasing penetration and health care related use of the Internet, we examined the evidence on the impact of Internet-based interventions on pain. A search of Medline, CINAHL, PsycINFO, and the Cochrane Library was conducted for literature published from 1990 to 2010 describing randomized controlled trials that assessed the effects of Internet-based interventions on patients with pain of any kind. Of 6724 citations, 17 articles were included. The studies evaluated the effects of interventions that provided cognitive and behavioral therapy, moderated peer support programs, or clinical visit preparation or follow-up support on 2503 people in pain. Six studies (35.3%) received scores associated with high quality. Most cognitive and behavioral therapy studies showed an improvement in pain (n=7, 77.8%), activity limitation (n=4, 57.1%) and costs associated with treatment (n=3, 100%), whereas effects on depression (n=2, 28.6%) and anxiety (n=2, 50%) were less consistent. There was limited (n=2 from same research group) but promising evidence that Internet-based peer support programs can lead to improvements in pain intensity, activity limitation, health distress and self-efficacy; limited (n=4 from same research group) but promising evidence that social networking programs can reduce pain in children and adolescents; and insufficient evidence on Internet-based clinical support interventions. Internet-based interventions seem promising for people in pain, but it is still unknown what types of patients benefit most. More well-designed studies with diverse patient groups, active control conditions, and a better description of withdrawals are needed to strengthen the evidence concerning the impact of Internet-based interventions on people in pain.

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    • "Numerosos estudios han demostrado que los sitios web pueden cambiar y mejorar el conocimiento de los pacientes con dolor crónico, y lo que es más importante, tienen un impacto positivo en sus actitudes y comportamiento [Berman et al. 2009; Caiata Zufferey and Schulz 2010; Høybye et al. 2005; Lorig et al. 2002; Murray et al. 2005; Shigaki et al. 2008; Weinert et al. 2009], especialmente para problemas físicos y de salud mental [Andersson, Bergström, Carlbring, et al. 2005; Andersson, Bergström, Holländare, et al. 2005; Glasgow et al. 2003; Krishna et al. 2003; Rini et al. 2012]. Bender y sus colaboradores [Bender et al. 2011] en una revisión sistemática de ensayos controlados aleatorios para el tratamiento del dolor a través de internet, llegaron a la conclusión de que las intervenciones que utilizan internet son prometedoras para el tratamiento del dolor, aunque se necesitan más estudios con mejores diseños metodológicos. "
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    DESCRIPTION: Theory about the experiments we actually do
    • "One meta-analysis of 22 studies found that Internetbased interventions can have greater effects than non–Internet-based interventions when used for specified knowledge or behavior change (Wantland, Portillo, Holzemer, Slaughter, & McGhee, 2004). Bender et al.'s (2011) systematic review of Internetbased pain programs included 17 studies and concluded that providing cognitive and behavioral therapy, moderated peer support, and follow-up support can have positive effects on pain, activity, and treatment costs. The anonymity afforded by the Internet was also believed to be advantageous considering the stigmatization of those with a persistent pain diagnosis. "
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    ABSTRACT: New strategies are needed to improve access to cognitive and behavioral therapies for patients with persistent pain. The purpose of this randomized, controlled trial was to determine the effectiveness of the Chronic Pain Management Program, an 8-week online intervention targeting cognitive, emotional, behavioral, and social pain determinants. Program efficacy and engagement was evaluated for 92 individuals with a diagnosis of chronic noncancer pain who had a current opioid prescription. Participants were recruited from primary care practices and Internet sites, then randomly assigned to receive access to the intervention either immediately (treatment group) or after an 8-week delay (wait-list comparison). Biweekly self-report measurements were collected using online surveys on pain, depressive symptoms, pain self-management behaviors, and health care utilization during the 8-week trial. Additional measurements of opioid misuse behaviors, pain self-efficacy, and medicine regimens were completed at baseline and week 8. Engagement was evaluated by examining completion of program learning modules. The results from analysis of variance showed that at week 8, the treatment group had significantly greater improvements on pain self-efficacy and opioid misuse measures than the wait-list comparison group. Engagement level was positively associated with improvements in pain intensity, pain interference, and pain self-efficacy. In conclusion, patients on opioids were able to engage and demonstrate positive outcomes using an Internet-based self-management program. Future efforts toward heightening engagement could further maximize impacts. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
    Pain management nursing: official journal of the American Society of Pain Management Nurses 06/2015; 16(4). DOI:10.1016/j.pmn.2014.09.009 · 1.53 Impact Factor
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    • "Of these sources, health care professionals are the most flexible and adaptable in their approach to providing patients with information [31]. Internet-based systems are flexible communication methods that deliver the latest, most up-to-date information [32], and their use for pain management has become popular [33]. Previous studies using Internet-based learning programs have reported reduced pain [34–36], facilitated knowledge acquisition [37], facilitated self-care education [38], and improved health status [39]. "
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    ABSTRACT: Background. Primary dysmenorrhea is prevalent in adolescents and young women. Menstrual pain and distress causes poor school performance and physiological damage. Auricular acupressure can be used to treat these symptoms, and Internet-based systems are a flexible way of communicating and delivering the relevant information. Objective. This study investigates the effects of auricular acupressure (AA) alone and combined with an interactive Internet-based (II) intervention for the management of menstrual pain and self-care of adolescents with primary dysmenorrhea. Design. This study adopts a pretest/posttest control research design with a convenience sample of 107 participants. Results. The outcomes were measured using the short-form McGill pain questionnaire (SF-MPQ), visual analogue scale (VAS), menstrual distress questionnaire (MDQ), and adolescent dysmenorrheic self-care scale (ADSCS). Significant differences were found in ADSCS scores between the groups, and in SF-MPQ, VAS, MDQ, and ADSCS scores for each group. Conclusion. Auricular acupressure alone and a combination of auricular acupressure and interactive Internet both reduced menstrual pain and distress for primary dysmenorrhea. Auricular acupressure combined with interactive Internet instruction is better than auricular acupuncture alone in improving self-care behaviors.
    Evidence-based Complementary and Alternative Medicine 04/2013; 2013(1):316212. DOI:10.1155/2013/316212 · 1.88 Impact Factor
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