The Cochrane Pain, Palliative and Supportive Care Group has produced more than 300 reviews and added to these in August 2023 with a review of remotely-delivered psychological therapies for chronic pain in adults. Here's one of the authors, Geoff Duggan formerly from the Bath Centre for Pain Services in the UK, to tell us about the importance of the review and its findings.
Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. The Cochrane Pain, Palliative and Supportive Care Group has produced more than 300 reviews and added to these in August 2023 with a review of remotely-delivered psychological therapies for chronic pain in adults. Here's one of the authors, Geoff Duggan formerly from the Bath Centre for Pain Services in the UK, to tell us about the importance of the review and its findings.
Geoff: Chronic pain is pain that has lasted three months or longer. It is a common experience that can significantly impact on a person's everyday life and well‐being. Psychological therapies have been found to improve mood and pain‐related disability but gaining access to these therapies can be difficult. There are limited numbers of qualified healthcare professionals providing these services, and some people may find it physically difficult to attend clinics. Technologies (such as mobile phones, computers, and the internet) may offer new ways of delivering psychological therapies directly to people within their everyday environment and without a healthcare professional being present. This approach (known as remote delivery) has the potential to help more people access therapy.
Therefore, we investigated whether remotely‐delivered psychological therapies improve pain, disability, and quality of life (i.e. well‐being across life as a whole) for adults with chronic pain. The 32 studies that we included in the review had recruited a total of nearly 5000 people with a range of chronic pain conditions, such as back pain, osteoarthritis, fibromyalgia, and rheumatoid arthritis. 25 of the studies investigated cognitive behavioural therapy (CBT, for short) and the other 7 tested acceptance and commitment therapy (or ACT). All of the studies delivered the therapy over the internet so we're not able to say anything about the alternative forms of remote delivery. This lack of evidence on different delivery technologies needs to be filled by high‐quality studies, and such studies are also needed to assess the broad translatability of psychological therapies to remote delivery, treatment longevity, comparison with active control, and adverse events.
Turning to the research that is currently available, we found moderate certainty evidence that, compared to usual treatment, remotely delivered CBT has a small benefit for pain intensity and low certainty evidence that it has a small benefit for functional disability. Compared to non‐psychological treatments for pain (such as education, online discussion boards), there was moderate certainty that remotely delivered CBT has a small benefit for pain intensity and no evidence for any benefit for functional disability. However, none of these benefits were maintained at follow‐up. Our appraisal of quality of life and adverse events outcomes post‐treatment was limited by lack of studies, low evidence certainty, or both. Likewise, our assessment of other psychological therapies, which because of the available studies is limited to ACT, is also hampered because of the low to very low certainty of the evidence.
The take home message, therefore, is that we found evidence that remotely‐delivered CBT has small benefits for pain intensity and functional disability in adults experiencing chronic pain.
Mike: If you'd like to find out more about these effects, you can read the full review online. Just go to Cochrane Library dot com and search 'remotely delivered psychological therapies for chronic pain' to see a link to it.