ABSTRACT

Comorbid psychological problems are commonly related to chronic pain but addressing heterogeneous comorbidities in traditional settings is often difficult. Delivering individually tailored treatment using the internet could be a viable alternative. The present study investigates whether a guided, individually tailored and internet-delivered cognitive behavioral therapy (ICBT) could improve mood and reduce disability in individuals suffering from chronic pain and comorbid psychological distress.

Participants were recruited from a pain clinic and randomized to either ICBT or waiting list. The participants (n = 187) individually tailored treatments included 6–13 modules targeting different types of psychological distress. Modules were designed to be completed weekly, and feedback was provided by clinicians. Participants completed an average of 5.1 (49.7%) modules, with 22.9% completing all assigned modules. Intention-to-treat analyses showed significantly larger improvements in depression, disability, pain acceptance, catastrophizing, and quality of life in the ICBT-group compared to the control group. Between-group effect sizes were very small or small at post for the primary outcomes depression (d = 0.18) and pain interference (d = 0.22). Other effect sizes ranged from very small to small, with the largest effect being improvements in pain acceptance (d = 0.3). All significant changes were stable at 12-month follow up.

摘要

共病心理问题通常与慢性疼痛有关，但在传统环境中解决异质性共病通常很困难。使用互联网提供个性化的治疗可能是一种可行的选择。本研究调查指导性、个性化定制和互联网提供的认知行为疗法 (ICBT) 是否可以改善患有慢性疼痛和共病心理困扰的个体的情绪并减少残疾。

参与者是从疼痛诊所招募的，并随机分配到 ICBT 或候补名单。参与者（n = 187）单独定制的治疗包括针对不同类型心理困扰的 6-13 个模块。模块设计为每周完成，并由临床医生提供反馈。参与者平均完成了 5.1 (49.7%) 个模块，其中 22.9% 完成了所有分配的模块。意向治疗分析显示，与对照组相比，ICBT 组在抑郁、残疾、疼痛接受、灾难性和生活质量方面的改善显着更大。对于主要结果抑郁（d = 0.18）和疼痛干扰（d= 0.22)。其他影响大小从非常小到小不等，最大的影响是疼痛接受度的提高（d = 0.3）。在 12 个月的随访中，所有显着变化均保持稳定。