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Cited by 157Musculoskeletal pain and rehabilitationDigital Mental Health InterventionsPain Management and Treatment

An Online Self-help CBT Intervention for Chronic Lower Back Pain

Open access
Carpenter, Kelly M., Stoner, Susan A., Mundt, Jennifer M., Stoelb, Brenda·2012·The Clinical Journal of Pain
DOI 10.1097/ajp.0b013e31822363dbPMC PMC3184315
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Abstract

OBJECTIVES: Research has shown that cognitive and behavioral therapies can effectively improve quality of life in chronic pain patients. Unfortunately, many patients lack access to cognitive and behavioral therapy treatments. We developed a pilot version of an interactive online intervention to teach self-management skills for chronic lower back pain, a leading cause of disability and work absenteeism. The objective of this randomized, controlled trial was to evaluate its efficacy. METHODS: Individuals with chronic lower back pain were recruited over the Internet, screened by phone, and randomly assigned to receive access to the intervention (Wellness Workbook; WW) either immediately (intervention group) or after a 3-week delay (wait-list control). Participants (n=141, 83% female, 23% minority) were asked to complete the WW over 3 weeks. Self-report measures of pain, disability, disabling attitudes and beliefs, self-efficacy for pain control, and mood regulation were completed at baseline, week 3, and week 6. RESULTS: Controlling for baseline individual differences in the outcome measures, multivariate analysis of covariance revealed that, at week 3, the intervention group scored better than the wait-list control group on all outcomes, including pain severity ratings. At week 6, after both groups had been exposed to the WW, there were no differences between groups. DISCUSSION: Use of this pilot intervention seems to have had positive effects on a number of pain-related outcomes, including disability. Future research will evaluate the effectiveness of the completed intervention, with particular attention to quality of life and disability.

AI snapshot

Written from the paper’s full text.

TL;DR

This randomized wait-list controlled trial found that a 3-week online self-help CBT program (Wellness Workbook) improved pain-related beliefs, self-efficacy, catastrophizing, fear avoidance, and disability in adults with chronic lower back pain, but did not reduce pain severity. Between-group differences disappeared by Week 6 after the wait-list group also received the intervention.

Key findings

  • At Week 3, the intervention group scored significantly better than wait-list controls on most outcomes: multivariate main effect \(F(18,109)=4.88, p<.001\). Univariate effects were significant for all measures except SOPA Medical Cure, FABQ Work, and pain severity ratings.
  • Improvements included stronger belief in pain control, less belief in disability/harm from exercise/medication need, better pain self-efficacy and mood regulation self-efficacy, and reduced pain catastrophizing and fear avoidance of physical activity. No significant change was found for pain severity.
  • At Week 6, after both groups had used the workbook, groups were functionally equivalent: \(F(15,101)=0.55, p=.909\).
  • Usage was high: 81% completed all six chapters; participants viewed an average of 153.9 (SD=48.0) of 189 pages and completed 5.3 (SD=1.7) of 6 chapters. The intervention group used the workbook on more days than the wait-list group (\(M=6.8\) vs. \(5.2\), \(p=.005\)).

Methods

  • Design: online randomized wait-list controlled trial. Participants were recruited via Internet bulletin boards and newspaper advertisements, screened by phone, and completed all measures online.
  • Sample: 230 screened, 66 ineligible, 164 eligible, and 141 completed baseline measures. Participants were aged 21–74 years (\(M=42.5\), \(SD=10.3\)); 83% were women; 23% were racial/ethnic minorities; they represented 40 states. Midway through recruitment, minimum age was raised to 40.
  • Intervention and analysis: the Wellness Workbook was a six-chapter, 189-page online CBT self-help program completed over 3 weeks at two chapters per week. Primary outcome was the Survey of Pain Attitudes (SOPA); other measures included FABQ, Negative Mood Regulation Scale, Pain Catastrophizing Scale, Roland-Morris Disability Questionnaire, adapted Pain Self-efficacy Scale, pain severity, and usability/satisfaction. Hypotheses were tested with MANCOVA controlling for baseline scores, with post-hoc paired t-tests using Bonferroni-corrected alpha of .003.

Limitations

  • The paper states that participants were required to complete at least four of six chapters; those who did not were considered dropouts and were not offered later assessments, so reasons for dropout were lost. Differential attrition occurred, with more wait-list participants dropping out, and more men than women left the study; the sample was primarily women, limiting generalizability.
  • The paper states that little is known about who benefits most from self-help or Internet-based therapies, and that age may affect willingness to engage online. It also notes that a wait-list control does not control for non-specific treatment effects and that an active control is needed.
  • Evident from the text: pain severity was not assessed at Week 6, and follow-up was limited to 6 weeks, so longer-term maintenance of gains was not evaluated.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1097/ajp.0b013e31822363db

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 46 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    At Week 3, the intervention group endorsed stronger belief that they could control their pain than the waitlist control group.

    “At Week 3, the intervention group (as compared to the waitlist control group) endorsed stronger belief that they could control their pain”
    Quote in the paperSubstantial claim
  • Findingown data

    No significant changes were noted with regard to pain severity.

    “No significant changes were noted with regard to pain severity.”
    Quote in the paperSubstantial claim
  • Findingown data

    On average, the INT group used the WW on more days than the WLC group (M = 6.8 vs M = 5.2).

    “such that, on average, the INT group (M = 6.8) used the WW on more days than the WLC group (M = 5.2).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Across conditions, 81% of participants completed all six chapters.

    “Across conditions, 81% of participants completed all six chapters.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The omnibus multivariate main effect of condition on usage data was significant, F(3, 131) = 2.96, p = .035.

    “The omnibus multivariate main effect of condition was significant, F(3, 131) = 2.96, p = .035.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 29
  • May combine two claims. 24

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The intervention and wait-list control group had somewhat different patterns of use of the workbook.

    “The intervention and wait-list control group had somewhat different patterns of use of the workbook.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no difference between conditions in number of unique pages visited or number of chapters completed.

    “There was no difference between conditions in terms of number of unique pages visited or number of chapters completed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Across conditions, participants viewed an average of 153.9 (SD = 48.0) out of 189 pages and completed 5.3 (SD = 1.7) out of 6 chapters.

    “Across conditions, participants viewed an average of 153.9 (SD = 48.0) out of 189 pages and completed 5.3 (SD = 1.7) out of 6 chapters.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sixty-five percent of participants in the INT group returned to the WW after the Week 3 assessment, i.e., after they had already completed the WW.

    “Sixty-five percent of participants in the INT group returned to the WW after the Week 3 assessment, i.e., after they had already completed the WW.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The present study did not shed any new light on who benefits most from self-help treatments.

    “and the present study did not shed any new light on the issue.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The intervention group showed improvement in self-efficacy for pain management and mood regulation.

    “Furthermore, the intervention group showed improvement in self-efficacy for pain management and mood regulation”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Within the INT group, baseline to Week 3 scores showed significant improvement for all outcomes except the Solicitude and Medical Cure subscales of the SOPA and the Work subscale of the FABQ.

    “Within the INT group, we compared baseline scores to Week 3 scores. Significant improvement (ps < .003) was noted for all outcomes except the Solicitude (p = .085) and Medical Cure (p = .322) subscales of the SOPA and the Work subscale of the FABQ (p = .032).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Percent of participants completing each chapter ranged from 84% (Chapter 5) to 94% (Chapter 1).

    “Percent of participants completing each chapter ranged from 84% (Chapter 5) to 94% (Chapter 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Although participants used the intervention for only three weeks, the study found changes on most cognitive measures and on disability ratings with medium to large effect sizes.

    “Although participants used the intervention for only three weeks, we found changes on most cognitive measures and on disability ratings with medium to large effect sizes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only 1% of participants reported using WW less than 2 hours per week; 59% reported using it at least 6 hours per week, and 28% at least 10 hours per week.

    “Only 1% of participants reported using WW less than 2 hours per week; 59% reported using it at least 6 hours per week, and 28% at least 10 hours per week.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The intervention group showed decreased pain catastrophizing and fearful avoidance of physical activity.

    “as well as decreased pain catastrophizing and fearful avoidance of physical activity.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The WW appears to have been well regarded on the Usability/Satisfaction Questionnaire.

    “In general, the WW appears to have been well regarded.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Turner et al reported good psychometric properties for a similarly modified SES, which focused on pain instead of arthritis.

    “Turner et al48 reported good psychometric properties for a similarly modified SES, which focused on pain instead of arthritis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Turner JA Ersek M Kemp C Self-efficacy for managing pain is associated with disability, depression, and pain coping among retirement community residents with chronic pain J Pain Jul 2005 6 7 471 479 15993826 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    The SOPA-32 is a well-validated 32-item measure with seven subscales that measure strength of endorsement of pain-related beliefs.

    “The SOPA-32 is a well-validated 32-item measure with seven subscales that measure strength of endorsement of pain-related beliefs”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [38] Klare GR A second look at the validity of readability formulas Journal of Reading Behavior 1976 8 129 152

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [39] Jensen MP Karoly P Pain-specific beliefs, perceived symptom severity, and adjustment to chronic pain Clin J Pain Jun 1992 8 2 123 130 1633376 source

      Not checked in the free run.

    • cites [40] Jensen MP Turner JA Romano JM Fisher LD Comparative reliability and validity of chronic pain intensity measures Pain Nov 1999 83 2 157 162 10534586 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    With regard to the dependent variables, independent groups t-tests revealed no significant differences between the groups on any dependent variable, with the exception of the Emotion subscale of the SOPA, t(139) = −2.15, p = .034.

    “With regard to the dependent variables, independent groups t-tests revealed no significant differences between the groups on any dependent variable, with the exception of the Emotion subscale of the SOPA, t(139) = −2.15, p = .034.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The authors have demonstrated strong construct validity, internal consistency, and two-week test-retest reliability for the SOPA.

    “The authors have demonstrated strong construct validity, internal consistency, and two-week test-retest reliability”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [14] Jensen MP Turner JA Romano JM Correlates of improvement in multidisciplinary treatment of chronic pain J Consult Clin Psychol Feb 1994 62 1 172 179 8034820 source

      Not checked in the free run.

    • cites [41] Jensen MP Turner JA Romano JM Changes in beliefs, catastrophizing, and coping are associated with improvement in multidisciplinary pain treatment J Consult Clin Psychol Aug 2001 69 4 655 662 11550731 source

      Not checked in the free run.

    • cites [42] Turner JA Jensen MP Romano JM Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain? Pain Mar 2000 85 1–2 115 125 10692610 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Acceptance and values-based action are important in chronic pain treatment.

    “two functional contextual approaches have been identified as being important in chronic pain treatment: acceptance and values-based action.20”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Wicksell RK Ahlqvist J Bring A Melin L Olsson GL Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial Cogn Behav Ther 2008 37 3 169 182 18608312 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    A password-protected document linking participant names to user IDs was maintained by the study coordinator, but this was not accessible to individuals involved in analyzing outcome data.

    “A password-protected document linking participant names to user IDs was maintained by the study coordinator, but this was not accessible to individuals involved in analyzing outcome data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cognitive and behavioral therapy (CBT) approaches to pain management have been used with chronic pain patients for many years.

    “Cognitive and behavioral therapy (CBT) approaches to pain management have been used with chronic pain patients for many years10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Flor H Fydrich T Turk DC Efficacy of multidisciplinary pain treatment centers: a meta- analytic review Pain May 1992 49 2 221 230 1535122 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Improvement in pain acceptance and values-based action predicted improvement in primary outcomes including pain-related anxiety, depression, and disability.

    “Vowles and McCracken23 found that improvement in pain acceptance and values-based action predicted improvement in primary outcomes including pain-related anxiety, depression, and disability.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Vowles KE McCracken LM Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process J Consult Clin Psychol Jun 2008 76 3 397 407 18540733 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A review of self-help for chronic pain found that self-help delivered via group formats, workbooks, books, audiotapes, minimal contact formats, and telephone delivery systems has been effectively used to reduce pain, pain-related disability, depression, and anxiety in arthritis, lower back pain, headache, and temporomandibular joint disorder.

    “A review of self-help for chronic pain25 found that self-help delivered via group formats, workbooks, books, audiotapes, minimal contact formats, and telephone delivery systems has been effectively used to reduce pain, pain-related disability, depression, and anxiety in arthritis,26,27 lower backpain,28,29 headache,30–32 and temporomandibular joint disorder.33,34”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [25] Buenaver LF McGuire L Haythornthwaite JA Cognitive-Behavioral self-help for chronic pain J Clin Psychol Nov 2006 62 11 1389 1396 16937351 source

      Not checked in the free run.

    • cites [26] Lorig K Holman H Arthritis self-management studies: a twelve-year review Health Educ Q Spring 1993 20 1 17 28 8444622 source

      Not checked in the free run.

    • cites [27] Lorig KR Ritter PL Laurent DD Fries JF Long-term randomized controlled trials of tailored-print and small-group arthritis self-management interventions Med Care Apr 2004 42 4 346 354 15076811 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Self-help interventions for chronic diseases such as chronic pain are cost-effective, more easily disseminated than traditional professional-led interventions, and serve to empower patients.

    “self-help interventions for chronic diseases such as chronic pain are cost-effective, more easily disseminated than traditional, professional-led interventions and serve to empower patients.24”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Smith BH Elliott AM Active self-management of chronic pain in the community Pain Feb 2005 113 3 249 250 15661429 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A meta-analysis of 22 randomized controlled trials concluded that psychological interventions are effective for CLBP, with cognitive-behavioral and self-regulatory interventions being particularly effective.

    “A meta-analysis of 22 randomized controlled trials concluded that psychological interventions are effective for CLBP, with cognitive-behavioral and self-regulatory (e.g., biofeedback, relaxation) interventions being particularly effective.12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Hoffman BM Papas RK Chatkoff DK Kerns RD Meta-analysis of psychological interventions for chronic low back pain Health Psychol Jan 2007 26 1 1 9 17209691 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Fear Avoidance Beliefs Questionnaire (FABQ) is a reliable and valid 16-item instrument that assesses patients' beliefs regarding the effects of physical activity and work on their lower back pain.

    “The Fear Avoidance Beliefs Questionnaire (FABQ)43 is a reliable and valid 16-item instrument that assesses patients’ beliefs regarding the effects of physical activity and work on their lower back pain”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Waddell G Newton M Henderson I Somerville D Main CJ A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability Pain Feb 1993 52 2 157 168 8455963 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Chi-square tests revealed no significant differences between the INT and WLC groups in terms of the proportions of women, racial/ethnic minorities, those completing more than 2 years of post-secondary education, those currently being treated for chronic pain, those currently taking medications, those who had tried opioids, and those whom opioids had helped.

    “Chi-square tests revealed no significant differences between the INT and WLC groups in terms of the proportions of women, racial/ethnic minorities, those completing more than 2 years of post-secondary education, those currently being treated for chronic pain, those currently taking medications, those who had tried opioids, and those whom opioids had helped.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Internet-based self-help interventions for chronic pain have been shown to be effective for a number of pain conditions, including headache, non-headache chronic pain, and rheumatoid arthritis, osteoarthritis, or fibromyalgia.

    “Internet-based self-help interventions for chronic pain have been shown to be effective for a number of pain conditions, including headache,35 non-headache chronic pain,36 and rheumatoid arthritis, osteoarthritis, or fibromyalgia.37”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [35] Devineni T Blanchard EB A randomized controlled trial of an internet-based treatment for chronic headache Behav Res Ther Mar 2005 43 3 277 292 15680926 source

      Not checked in the free run.

    • cites [36] Buhrman M Faltenhag S Strom L Andersson G Controlled trial of Internet-based treatment with telephone support for chronic back pain Pain Oct 2004 111 3 368 377 15363881 source

      Not checked in the free run.

    • cites [37] Lorig KR Ritter PL Laurent DD Plant K The internet-based arthritis self-management program: a one-year randomized trial for patients with arthritis or fibromyalgia Arthritis Rheum Jul 15 2008 59 7 1009 1017 18576310 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Because the groups were slightly different at baseline, we elected to use multivariate analysis of covariance (MANCOVA) to test our hypotheses, controlling for baseline individual differences in the dependent measures.

    “Because the groups were slightly different at baseline, we elected to use multivariate analysis of covariance (MANCOVA) to test our hypotheses, controlling for baseline individual differences in the dependent measures.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Upon completion of the baseline measures, participants were randomized to the intervention (INT) group or to a wait-list control (WLC) group using a random number table.

    “Upon completion of the baseline measures, participants were randomized to the intervention (INT) group or to a wait-list control (WLC) group using a random number table.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Independent-groups t-tests revealed no significant differences between the INT and WLC groups in terms of age, average pain rating, or duration of chronic pain.

    “Independent-groups t-tests revealed no significant differences between the INT and WLC groups in terms of age, average pain rating, or duration of chronic pain.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    Chronic lower back pain (CLBP) is a significant public health problem.

    “In sum, CLBP is a significant public health problem.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] CDC N, ed Healthy People 2010: 2 Arthritis, Osteoporosis, and Chronic Back Conditions 12006

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [2] Hardt J Jacobsen C Goldberg J Nickel R Buchwald D Prevalence of chronic pain in a representative sample in the United States Pain Medicine 2008 9 7 803 812 18346058 source

      Not checked in the free run.

    • cites [3] Lawrence RC Helmick CG Arnett FC Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States Arthritis Rheum May 1998 41 5 778 799 9588729 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The evidence is perhaps strongest for the treatment of headache, with home-based, self-help interventions resulting in comparable or superior outcomes to clinic-based treatments.

    “The evidence is perhaps strongest for the treatment of headache, with home-based, self-help interventions resulting in comparable or superior outcomes to clinic-based treatments.31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Haddock CK Rowan AB Andrasik F Wilson PG Talcott GW Stein RJ Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials Cephalalgia Apr 1997 17 2 113 118 9137849 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Buenaver, McGuire, and Haythornthwaite have posited that an increase in self-efficacy mediates the relationship between self-help interventions and subsequent reductions in pain and disability.

    “Furthermore, Buenaver, McGuire, and Haythornthwaite25 have posited this increase in self-efficacy mediates the relationship between self-help interventions and subsequent reductions in pain and disability”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Buenaver LF McGuire L Haythornthwaite JA Cognitive-Behavioral self-help for chronic pain J Clin Psychol Nov 2006 62 11 1389 1396 16937351 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Compared to completers, Week 6 non-completers were more likely to be in the WLC group, χ2(1) = 4.06, p = .044, N = 141; racial/ethnic minorities, χ2(1) = 13.29, p < .001, N = 138.

    “Chi-square tests revealed that compared to completers, Week 6 non-completers were more likely to be in the WLC group (see Figure 1), χ2(1) = 4.06, p = .044, N = 141; racial/ethnic minorities, χ2(1) = 13.29, p < .001, N = 138.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Chi-square tests revealed no significant differences between Week 3 completers and non-completers with regard to racial/ethnic minority status, educational attainment, or chronic pain treatment, nor did they differ according to group assignment.

    “Chi-square tests revealed no significant differences between Week 3 completers and non-completers with regard to racial/ethnic minority status, educational attainment, or chronic pain treatment, nor did they differ according to group assignment.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Our initial sample was primarily made up of individuals in their twenties and thirties.

    “Our initial sample was primarily made up of individuals in their twenties and thirties.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    This rapid change is perhaps due to the acceptance of an internally consistent and meaningful treatment rationale.

    “This rapid change is perhaps due to the acceptance of an internally consistent and meaningful treatment rationale.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation

    Introducing a mind/body treatment rationale, thus encouraging patients to try new ways to manage their own pain, is empowering and enhances self-efficacy.

    “we postulate that introducing a mind/body treatment rationale, thus encouraging patients to try new ways to manage their own pain is empowering and enhancesself-efficacy.24”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Smith BH Elliott AM Active self-management of chronic pain in the community Pain Feb 2005 113 3 249 250 15661429 source

      Not checked in the free run.

    • The authors state this as an assumption: To be successful, patients need sufficient motivation to make the time to use the materials on their own and sufficient receptiveness to the mind/body treatment rationale.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Compared to completers, Week 3 non-completers were more likely to be men, χ2(1) = 4.02, p = .045, N = 141; less variable in age, Levene's F = 4.04, p = .046; older (M = 47.7 vs. 42.0), t(13.2) = 2.60, p = .022; and in lower average pain, t(139) = −2.20, p = .029.

    “Compared to completers, Week 3 non-completers were more likely to be men, χ2(1) = 4.02, p = .045, N = 141; less variable in age, Levene’s F = 4.04, p = .046; older (M = 47.7 vs. 42.0), t(13.2) = 2.60, p = .022; and in lower average pain, t(139) = −2.20, p = .029.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Self-help interventions delivered via the internet may be ideal for persons living with chronic lower back pain.

    “In several ways self-help interventions delivered via the internet may be ideal for persons living with chronic lower back pain.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Multidisciplinary treatment for chronic pain (including non-pharmacological treatment) is considered the gold standard by numerous healthcare organizations.
    • Rests on an assumption: Many people may find seeing a psychologist or mental health practitioner stigmatizing.
    • Rests on an assumption: Comprehensive or multidisciplinary pain treatment programs may not be accessible for a substantial number of patients, as they tend to be located in large, urban areas and require a high level of commitment.
    • Rests on an assumption: Comprehensive or multidisciplinary pain treatment programs are expensive and may not be covered by insurance companies.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    A wait-list control group does not control for non-specific effects of treatment as it is comparing the online treatment to no treatment.

    “Finally, a wait-list control group does not control for non-specific effects of treatment as it is comparing the online treatment to no treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    These changes can be maintained over long periods of time.

    “and that these changes can be maintained over long periods of time.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Buenaver LF McGuire L Haythornthwaite JA Cognitive-Behavioral self-help for chronic pain J Clin Psychol Nov 2006 62 11 1389 1396 16937351 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The Internet can be an efficient and effective tool for delivering evidence-based interventions.

    “this study demonstrates that it can also be an efficient and effective tool for delivering evidence-based interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    There were more female participants in the initial sample, leading to a study sample primarily comprised of women.

    “There were also more female participants in the initial sample, leading to a study sample primarily comprised of women.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Little remains known regarding who benefits most from self-help treatments.

    “Little remains known regarding who benefits most from self-help treatments,25”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Buenaver LF McGuire L Haythornthwaite JA Cognitive-Behavioral self-help for chronic pain J Clin Psychol Nov 2006 62 11 1389 1396 16937351 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Web-based self-help interventions have been shown to have notable benefits with a variety of patient populations with pain.

    “Furthermore, web-based self-help interventions have been shown to have notable benefits with a variety of patient populations with pain.49–52”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [49] Allen M Iezzoni LI Huang A Huang L Leveille SG Improving patient-clinician communication about chronic conditions: description of an internet-based nurse E-coach intervention Nurs Res Mar-Apr 2008 57 2 107 112 18347482 source

      Not checked in the free run.

    • cites [50] Brattberg G Internet-based rehabilitation for individuals with chronic pain and burnout: a randomized trial Int J Rehabil Res Sep 2006 29 3 221 227 16900043 source

      Not checked in the free run.

    • cites [51] Brattberg G Internet-based rehabilitation for individuals with chronic pain and burnout II: a long-term follow-up Int J Rehabil Res Sep 2007 30 3 231 234 17762769 source

      Not checked in the free run.

    • cites [52] Sciamanna CN Nicholson RA Lofland JH Manocchia M Mui S Hartman CW Effects of a Website designed to improve the management of migraines Headache Jan 2006 46 1 92 100 16412156 source

      Not checked in the free run.

45 of 45

  • The paper relies on this without support.

    Cognitive and behavioral techniques for chronic pain have few if any negative side effects and, once learned, can be used by patients nearly anywhere and anytime.

    “These techniques have few if any negative side effects and, once learned, can be used by patients nearly anywhere and anytime.”

  • The paper relies on this without support.

    Therapeutic content of the WW was drawn from established and empirically-supported cognitive and behavioral strategies.

    “Therapeutic content was drawn from established and empirically-supported cognitive and behavioral strategies, including cognitive therapy, behavioral activation, acceptance and commitment therapy, and mindfulness-based stress reduction.”

  • The paper relies on this without support.

    The Joint Commission requires that pain management plans include non-pharmacological methods of pain control for patients in both inpatient and outpatient settings.

    “The Joint Commission, which accredits and certifies more than 18000 health care organizations and programs in the United States, specifically requires that pain management plans include non-pharmacological methods of pain control for patients in both inpatient and outpatient settings.”

  • The paper relies on this without support.

    Managing chronic pain, including CLBP, often necessitates both pharmacological and non-pharmacological strategies.

    “Managing chronic pain, including CLBP, often necessitates both pharmacological and non-pharmacological strategies.”

  • The paper relies on this without support.

    Multidisciplinary treatment for chronic pain (including non-pharmacological treatment) is considered the gold standard by numerous healthcare organizations.

    “although multidisciplinary treatment for chronic pain (which includes non-pharmacological treatment) is now considered the “gold standard” by numerous healthcare organizations”

  • The paper relies on this without support.

    Many people may find seeing a psychologist or mental health practitioner stigmatizing.

    “many people may find seeing a psychologist or mental health practitioner stigmatizing.”

  • The paper relies on this without support.

    Comprehensive or multidisciplinary pain treatment programs may not be accessible for a substantial number of patients, as they tend to be located in large, urban areas and require a high level of commitment.

    “comprehensive or multidisciplinary pain treatment programs may not be accessible for a substantial number of patients, as they tend to be located in large, urban areas and require a high level of commitment (such as daily attendance for several weeks).”

  • The paper relies on this without support.

    Comprehensive or multidisciplinary pain treatment programs are expensive and may not be covered by insurance companies.

    “They are also expensive, and may not be covered by insurance companies.”

  • The paper relies on this without support.

    Seeking external causes/treatments for pain can be common in, and problematic for, persons with CLBP.

    “Because seeking external causes/treatments for pain can be common in, and problematic for, persons with CLBP”

  • The authors state this as an assumption.

    To be successful, patients need sufficient motivation to make the time to use the materials on their own and sufficient receptiveness to the mind/body treatment rationale.

    “Presumably, to be successful, patients need sufficient motivation to make the time to use the materials on their own and sufficient receptiveness to the mind/body treatment rationale.”
10 of 10

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(139) = -2.15reported p = .034 · recomputed p = .033

    “t(139) = −2.15, p = .034”

  • Consistentχ²(1) = 4.02reported p = .045 · recomputed p = .045

    “χ2(1) = 4.02, p = .045”

  • Consistentt(13.2) = 2.6reported p = .022 · recomputed p = .022

    “t(13.2) = 2.60, p = .022”

  • Consistentt(139) = -2.2reported p = .029 · recomputed p = .029

    “t(139) = −2.20, p = .029”

  • Consistentχ²(1) = 4.06reported p = .044 · recomputed p = .044

    “χ2(1) = 4.06, p = .044”

  • Consistentχ²(1) = 13.29reported p < .001 · recomputed p < .001

    “χ2(1) = 13.29, p < .001”

  • ConsistentF(3, 131) = 2.96reported p = .035 · recomputed p = .035

    “F(3, 131) = 2.96, p = .035”

  • ConsistentF(1, 135) = 8.14reported p = .005 · recomputed p = .005

    “F(1, 135) = 8.14, p = .005”

  • ConsistentF(18, 109) = 4.88reported p < .001 · recomputed p < .001

    “F(18, 109) = 4.88, p < .001”

  • ConsistentF(15, 101) = 0.55reported p = .909 · recomputed p = .905

    “F(15, 101) = 0.55, p = .909”

10 of 10

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Mood-regulation scale labels conflict with score interpretation

    Minor

    The scale labels both 1 and 5 as "strongly disagree," yet says higher scores indicate stronger mood-regulation self-efficacy. For the positively worded example item, a score of 5 as labeled would indicate disagreement, not stronger self-efficacy.

1 of 1

Cites

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Cited by

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Related

Authors
Carpenter, K. M., Stoner, S. A., Mundt, J. M., & Stoelb, B.
Affiliations
Talaria (United States) (US)
ORCID
Venue
The Clinical Journal of Pain
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2012-01
Volume
28
Issue
1
Pages
14-22
ISSN
0749-8047 (ISSN-L)
DOI
10.1097/ajp.0b013e31822363db
PMC
PMC3184315
OpenAlex
W2066657052
Semantic Scholar
3418bdb9f67d17755cee144eecf73b24862fad90
Cited by
157
References
56
Citations by year
2026: 3 · 2025: 7 · 2024: 9 · 2023: 13 · 2022: 11 · 2021: 12 · 2020: 9 · 2019: 13 · 2018: 11 · 2017: 13 · 2016: 11 · 2015: 11 · 2014: 15 · 2013: 12 · 2012: 6
FWCI
7.97
Type
journal article
Language
en
Open access
Locations
  • Clinical Journal of Pain (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Arthritis and Musculoskeletal and Skin Diseases (R43AR052569)
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 low back pain, cognitive behavioral therapy, online self-help intervention, self-management skills, pain-related disability, pain intensity, self-efficacy, mood regulation, digital health interventions
MeSH terms
Adult, Aged, Chronic Disease, Disability Evaluation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Online Systems, Pain Measurement, Time Factors, Cognitive Behavioral Therapy, Multivariate Analysis, Treatment Outcome, Low Back Pain, Young Adult, Self Report

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

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