Two years on … do we know whether the internet can help to manage chronic pain?

It was just over two years ago when we were kindly invited to write a blog post for BodyInMind, which summarised our initial work trying to develop an internet-delivered pain management program. The eCentreClinic Team and I have been very busy since then.

Why try to develop an internet-delivered pain management program? Well, research tells us that unfortunately around 1 in 10 Australians experience chronic pain that substantially interferes with their day-to-day activities, emotional wellbeing and overall quality of life. That’s more than 2 million Australians. And, these statistics are not unique to Australia – chronic pain is common worldwide.

Research also suggests that people with chronic pain benefit from really good information about chronic pain.[1] And, they also benefit from learning and using several core skills for managing the impact of pain on their day-to-day activities and their emotional wellbeing.[2] Traditionally, this information and these skills have only been available via specialised face-to-face pain management programs, and some self-help books and websites. However, we know that very few people with chronic pain can access pain management programs, and most self-help books and websites are never evaluated – so we can’t be sure just how helpful they are.

The Pain Course …

Because of this we decided to create the Pain Course. It is an 8 week online course that consists of 5 core lessons and do-it-yourself homework tasks as well as lots of additional resources, case stories and real-world examples from past participants with chronic pain. It was carefully designed to cover everything covered in specialist face-to-face pain management programs. However, we wanted to make sure it could be accessed for free and from the convenience of people’s homes. Our first trial of the Pain Course was very encouraging, with participants reporting significant improvements in their pain, disability, anxiety and depression levels.[3] More than 90% reported that the course was worth their time and they’d recommend it to others.

The results of a recent trial …

With support from the Motor Accidents Authority of NSW and the National Health and Medical Research Council, we have recently completed another trial of the Pain Course involving more than 470 Australians from across the country.[4] You can read a scientific paper describing the study HERE for free. In this study we were interested in how much clinician support (e.g., telephone and email contact) people needed to successfully work through the Pain Course.

We randomly allocated participants (after an initial telephone interview and discussion) to receive the Pain Course with regular clinician contact, the option of contact, or no clinical contact – or, a control group. To our surprise, no marked or consistent differences were found based on the level of contact participants received during the Pain Course – that is, whether or not they had contact with a clinician supporting them through the course. Participants in the Pain Course reported average improvements of at least:

  • 12% in their pain levels (vs. 5% in control)
  • 18% in their day-to-day disability levels (vs. 3% in control)
  • 32% in their anxiety levels (vs. 0% in control)
  • 36% in their depression levels (vs. -1% in control)

Results were maintained or further improved when we followed people up 3 month after the course – we’re now just completing the long-term follow-up of participants and it looks like the improvements last for at least 2 years. Reflecting this, more than 90% report that the Pain Course was worth their time and that they would recommend it to others.

We are really excited by these results – and, encouraged by the feedback and support we have received. The results highlight the potential of carefully-developed and administered internet-delivered pain management programs for Australians with chronic pain. For example, the Pain Course is obtaining very good clinical outcomes (although there is always room for improvement) and participants can work through the course relatively independently. This means it can potentially be made available to lots of people without much cost or burden – our goal is to keep it entirely free for everyone. The course is also very convenient, especially for people who are living in rural or remote areas and people who for other reasons cannot easily access face-to-face pain management programs – e.g., due to mobility issues, cost, time, stigma and long waiting times. So, the Pain Course has the potential to increase access to pain management for Australians who might otherwise have never be able to participate in an effective pain management program.

Where to from here …

Internet-delivered pain management programs are promising but they are not a panacea. Good medical assessment and management is essential, and some participants need more intensive and tailored help than can be provided via the internet.

One of the challenges is to figure out who benefits from internet-delivered pain management programs, so we can make sure that people are quickly supported if they need more help. Other major challenges include making sure internet-delivered programs are as helpful as possible for specific groups with chronic pain who may have particular needs (e.g., Australians with spinal cord injuries, children and adolescents with chronic pain) and seeing if we can make internet-delivered pain management programs more accessible in Australia and internationally (e.g., currently very few proven programs are available worldwide). So, there’s still lots of work to do from here …

We would like to gratefully and sincerely acknowledge all of the participants in our research for their support and feedback, which helps us to continually develop the Pain Course for future participants. The authors also thank the Motor Accident’s Authority (MAA) of NSW, National Health and Medical Research Council (NHMRC), Chronic Pain Australia, Pain Australia, the ACI Pain Network, the Australian Pain Management Association and Arthritis Australia for their essential support of this research to date. 

About Blake Dear

Blake DearBlake Dear is a Co-Director of the eCentreClinic and a National Health and Medical Research Council (NHMRC) Public Health Fellow at Macquarie University, Sydney. He has a strong interest in developing innovative self-help programs that improve access to evidence-based treatment for people with common mental and chronic health conditions, especially people with chronic pain.

References

[1] Moseley, L. G., Butler, D. S. (2015). Fifteen years of explaining pain: The past, present, and the future. The Journal of Pain, 16, 807-813.

[2] Nicholas, M. K., Asghari, A., Corbett, M., SMeets, R. J., Wood, B. M., Overton, S., Perry, C., Tonkin, L. E., Beeston, L. (2012). Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain? European Journal of Pain, 16, 93-104.

[3] Dear, B. F., Titov, N., Nicholson Perry, K., Johnston, L., Wootton, B. M., Terides, M. D., Rapee, R. M., & Hudson, J. L. (2013). The Pain Course: A randomised controlled trial of clinician-guided internet-delivered cognitive behaviour therapy program for managing chronic pain and emotional wellbeing. Pain, 154, 942-950.

[4] Dear, B. F., Gandy, M., Karin, E., Staples, L. G., Johnston, L., Fogliati, V., Wootton, B. M., Terides, M. D., Kayrouz, R., Nicholson Perry, K., Sharpe, L., Nicholas, M. K., & Titov, N. (in press). The Pain Course: A randomised controlled trial examining an internet delivered pain management program when provided with different levels of clinician support. Pain.