The timing and magnitude of improvements in depression, anxiety, disability, and pain intensity during an internet-delivered program for chronic pain
Open accessAbstract
Numerous studies have found that pain management programs are an effective treatment option for people with chronic pain. However, little is known about when people experience improvements during these programs and why they are effective. Using a secondary analysis, the current study examined the timing and magnitude of symptom change during an 8-week internet-delivered psychological pain management program for people with chronic pain. The change in 4 outcomes was examined: depression (n = 881), anxiety (n = 561), disability (n = 484), and pain intensity (n = 484). The largest improvements in depression, anxiety, and disability were reported during the first half of treatment (ie, 4 weeks), whereas the largest reductions in pain intensity were reported during the second half of treatment. Half the participants had experienced a clinically meaningful improvement in depression or anxiety, and a third of participants had reported such an improvement in disability by midtreatment (ie, 5 weeks after baseline). In a subgroup analysis (n = 397), this pattern of change in depression and anxiety symptoms did not differ based on the level of therapist guidance. This study highlights the importance of the first few weeks of psychological pain management programs and encourages future work to examine how the mechanisms underpinning rapid change may be harnessed to optimize care for people with chronic pain. PERSPECTIVE: This study found that depression, anxiety, and disability improved rapidly during the first half of an 8-week internet-delivered pain management program, and most of the prepost change had occurred by midtreatment. This work highlights the therapeutic potential of the first few treatment sessions and prompts future research into a rapid responding.
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Clinical improvements were comparable within the treatment conditions of RCT2 and RCT3, so the treatment conditions were considered equal and amalgamated into one Treatment group per RCT.
“Analyses showed clinical improvements were comparable within the treatment conditions of both RCTs.Accordingly, the treatment conditions were considered equal and amalgamated into one 'Treatment' group per RCT for the purpose of this study and previously published studies.41,42”
From Internet-Delivered Psychological Pain-Management for Young Adults With Chronic Pain: An Investigation of Clinical Trial Data (2024) · cites this paper as [42]
The Participants section (page unavailable) says treatment participants from three prior RCTs received the same course and were collapsed into a single sample. The Conclusions section reports no significant difference in the timing of depression and anxiety improvement across guidance conditions. The paper does not say that conditions within RCT2 and RCT3 were deemed equal and amalgamated into one Treatment group per RCT, or that this was done in previously published studies. (LLM, conf=0.84)
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- Authors
- Bisby, M. A., Chandra, S. S., Scott, A. J., Dudeney, J., Titov, N., & Dear, B. F.
- Affiliations
- Macquarie University (AU)
- ORCID
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2023-11
- Volume
- 24
- Issue
- 11
- Pages
- 1968-1979
- ISSN
- 1526-5900 (ISSN-L)
- OpenAlex
- W4383879242
- Cited by
- 4
- References
- 49
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 1
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic pain, online intervention, psychological pain management, depression, anxiety, disability, pain intensity, symptom change over time, therapist guidance, therapeutic mechanisms
- MeSH terms
- Anxiety, Anxiety Disorders, Depression, Humans, Pain Measurement, Treatment Outcome, Internet, Chronic Pain
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