Guided Internet-delivered Cognitive-behavioral Therapy for Former Chronic Pain Patients

Study Overview
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Brief Summary
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The aim of the present study was to investigate if guided Internet-delivered Cognitive-behavioral Therapy (CBT) would help chronic pain patients who had previously undergone a multidisciplinary treatment but still have residual problems.

Detailed Description
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The present study investigates Internet-delivered CBT as a tertiary intervention. This is motivated by the fact that many pain patients relapse after rehabilitation and some may be in need of additional treatment. The persons who fulfills the inclusion criteria undergoes a structured telephone interview. The study is a experimental design with a treatment and an active control group measured before and after a treatment period. The control group were invited to participate in a moderated online discussion forum. Follow up data was collected six months after the treatment.

Official Title
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Guided Internet-delivered Cognitive-behavioral Therapy for Former Chronic Pain Patients: Randomised Controlled Trial

Conditions
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Chronic Pain

Intervention / Treatment
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* Behavioral: Guided Internet-based cognitive behavioural treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: to have been medically investigated (within one year) completed the multidisciplinary rehabilitation program have residual symptoms after the rehabilitation treatment (defined as functional impairment caused by their pain) have Internet access Exclusion Criteria: planned surgery ongoing medical investigation that could impede participation in the study suffering from acute physical or psychological conditions people confined to wheelchairs people not fluent with the Swedish language

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Internet delivered CBT<br>Internet delivered cognitive behavioral intervention, 8 weeks treatment. | Behavioral: Guided Internet-based cognitive behavioural treatment<br>* Eight weeks internet-based cognitive behavioural treatment. Treatment consisted of education, cognitive skills acquisition, behavioural rehearsal, generalization and maintenance.<br>|
| No Intervention: No intervention<br>Waitlist | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Coping Strategies Questionnaire (CSQ) | The CSQ contains 50 items divided in eight scales that measures different cognitive and behavioral coping strategies. The different coping strategies are: diverting attention, re-interpreting pain sensations, coping self-statements, ignoring sensations, praying and hoping, catastrophizing, increased behavioral activities and pain behavior (Rosenthiel & Keefe, 1983). Change from baseline in the different subscales pre- and post treatment. | One week pre treatment, one week post treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital Anxiety and Depression Scale, HADS | HADS is a 14-item questionnaire, and is designed to measure anxiety and depression in non-psychiatric patients. | One week pre treatment, one week post treatment | 
| Multidimensional Pain Inventory, MPI | MPI, assess psychosocial and behavioural consequences of pain. It´s divided into 2 sections and consisting of 8 scales. These are: Pain Severity, Interference, Life Control, Affective Distress, Support, Punishing Responses, Solicitous Responses and Distracting Responses. | One week pre treatment, one week post treatment | 
| Pain and Impairment Relationship Scale (PAIRS) | PAIRS consist of 15 personal statements that reflect thoughts, attitudes and opinions about pain. The questionnaire assesses beliefs and attitudes that patients have regarding pain and ability to function despite discomfort. | One week pre treatment, one week post treatment | 
| Quality of Life Inventory (QOLI) | QOLI contains 32 items for assessing life satisfaction. The assessment yields an overall score and profile in 16 areas of life; health, self-esteem, goals and values, money, work, play, learning, creativity, helping, love, friends, children, relatives, home, neighborhood and community. Each item is rated in terms of importance and satisfaction. | One week pre treatment, one week post after treatment | 
| Chronic Pain Acceptance Questionnaire (CPAQ) | CPAQ contains 20 items divided in two scales, engagement and willingness. CPAQ measures acceptance in relation to chronic pain. | One week pre treatment, one week post treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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mindfulness, applied relaxation, guided self help, chronic pain, internet delivered CBT, tertiary intervention