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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    • "Insufficient Lay peer support for improving ADL (1 review; 1 RCT) Internet-based peer-moderated self-management people with arthritis – insufficient evidence. Firm conclusions could not be drawn from a single study, despite finding a significant reduction in activity limitation Narrative review (Bender et al. 2011) Increasing social participation Inconsistent Physical activity for increasing social participation (1 review; 4 RCTs) Exercise programmes on improving social participation for people with clinical depression – Mixed findings. Two studies found evidence of a positive impact and two did not. "
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    ABSTRACT: Adult social care continues to be a central policy concern in the UK. The Adult Social Care Outcomes Framework (ASCOF) is a range of measures nationally available to drive forward improvement on outcomes and quality in local councils. While there is an emphasis on improving transparency, quality and outcomes, drawing on research evidence to achieve these aims is often difficult because the evidence is not easily identifiable, is disparate or of variable quality. We conducted a meta-review to analyse and summarise systematic review-level evidence on the impact of interventions on the four outcomes set out in the ASCOF: quality of life, delaying and reducing the need for services, satisfaction with services and safeguarding of vulnerable adults. This paper focuses on the availability of review-level evidence and the presence of significant gaps in this evidence base. A range of health and social care databases were searched, including MEDLINE, ASSIA and The Cochrane Library in January and February 2012. All systematic reviews evaluating the efficacy of social care interventions for improving ASCOF outcomes for older people, people with long-term conditions, mental health problems or physical and/or learning disabilities were eligible. Two reviewers independently screened systematic reviews for quality and relevance and extracted data; 43 systematic reviews were included, the majority of which examined the impact of interventions on quality of life (n = 34) and delaying and reducing the need for support (n = 25). Limited systematic review-level evidence was found regarding satisfaction with services and safeguarding. There were also significant gaps in relation to key social care interventions and population groups. Research priorities include addressing these gaps and the collation of data on interventions, outcomes and populations more closely related to social care. Overall, a more relevant, comprehensive and robust evidence base is required to support improvement of outcomes for recipients of adult social care.
    Health & Social Care in the Community 10/2015; DOI:10.1111/hsc.12300 · 1.15 Impact Factor
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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.
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