Treatment of chronic pain requires an approach that includes psychological intervention for success. A recent report suggests that non-pharmacologic therapies may be at least as effective as medications in treating chronic pain, and the Internet may prove to be a valuable method for delivering these interventions. Before you shake your head that this can’t be true, read on.
Medications alone are of only modest benefit and rarely lead to clinically meaningful functional improvement among patients with chronic pain. There is strong evidence, however, for non-pharmacologic therapies such as cognitive-behavioral therapy in improving functional status and mood, as well as pain itself.
Yes, we are talking about cognitive-behavioral therapy again. An analysis of 25 papers found that psychological treatments with cognitive-behavioral therapy (CBT) resulted in greater improvements in pain experience, coping, and behavioral expressions of pain, compared to other active treatments.
• In patients with chronic low back pain psychological interventions – particularly CBT – have been shown to reduce pain intensity and depression while improving quality of life.
• In fibromyalgia patients non-pharmacologic therapies had a greater effect than medications for fibro pain.
For 30 years the effectiveness of non-pharmacologic therapy in those with chronic pain rivals and even surpasses some pharmacologic approaches, yet non-pharmacologic interventions are rarely used in clinical practice.
The sad truth is that the use of non-pharmacologic treatment has been limited for a variety of reasons: medical schools don’t spend much time teaching it, insurance companies don’t adequately cover it, patients don’t have easy access to it, and it lacks the marketing that pharmaceutical companies devote to their drugs.
Can we solve those issues by delivering these interventions via the internet? Cost, access and convenience are obviously better. If so, what Web-based interventions work?
• E-mail discussion groups have shown good results in studies. In people with chronic low back pain a moderated e-mail discussion group combined with a workbook and videotape about back pain resulted in significant improvements in pain, disability, and distress after 1 year.
• A study of 56 patients with chronic low back pain who were given 8 weeks of either Internet-based CBT with telephone support or nothing showed at 3 months those who had treatment showed significant improvements in control over pain, and ability to decrease pain.
• PainAction. This web site for people with chronic back pain was based on CBT and self-management principles, including goal setting, problem solving, relapse prevention, nutrition, stress management, and exercise. At 6 months, significant changes were seen in pain, depression, and anxiety.
Clearly, we need to expand our Internet-based resources for the treatment for pain. It is interesting and too hard to ignore that pursuing non-pharmacologic treatment may be one of our best tools against chronic pain.