Web-Based Interventions for Chronic Back Pain: A Systematic Review
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BACKGROUND: Chronic low back pain is one of the most common presenting complaints to a physician's office. Treatment is often challenging and recovery depends on various factors, often resulting in significant investments of time and resources. OBJECTIVE: The aim of this review is to determine which Web-based interventions aimed at chronic low back pain are of benefit to patients. METHODS: Randomized controlled trials (RCTs) studying Web-based interventions directed at adults with chronic low back pain were included. Retrospective studies, narrative reviews, nonrandomized trials, and observational studies were excluded. Electronic databases and bibliographies were searched. RESULTS: In total, nine unique RCTs were identified (total participants=1796). The number of patients randomized in each trial ranged from 51 to 580. Four trials studied online cognitive behavioral therapy (CBT) and five trials studied other Web-based interventions with interactive features. Empowerment/control was improved in six studies. Use of CBT was associated with reduced catastrophization among patients. Mixed results were reported with regards to reduction in pain levels and disability, although some studies showed promise in reducing disability in the short term. One study that measured health care utilization reported reduced utilization with the use of moderated email discussion. CONCLUSIONS: Limited data are available regarding effective Web-based interventions to improve outcomes for patients with chronic low back pain. Nine RCTs with small sample sizes were identified in this review. Online CBT appears to show some promise in terms of reducing catastrophization and improving patient attitudes. Further research in this area with larger-scale studies focusing on appropriate outcomes appears to be a priority.
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Web-based CBT has been shown to be effective for reducing catastrophization and improving the attitudes of patients with MSK conditions to exercise therapy.
“Web-based CBT has been shown to be effective for reducing catastrophization and improving the attitudes of patients with MSK conditions to exercise therapy [44].”
From Development and usability testing of a web-based and therapist-assisted coping skills program for managing psychosocial problems in individuals with hand and upper limb injuries: Mixed methods study (2020) · cites this paper as [44]
The Results (Studies Using Online Cognitive Behavioral Therapy; page not provided) report reduced catastrophization in patients with chronic back pain. One trial also found that controls were more likely than CBT recipients to believe they should avoid exercise, but the review does not establish improved attitudes toward exercise therapy across MSK conditions. The Discussion describes the evidence as promising rather than conclusive. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPrevious systematic reviews on Web-based interventions for pain concluded that results were promising in terms of pain reduction and improvement of functional and emotional well-being.
“Overall, their authors concluded that results were promising in terms of pain reduction, and improvement of functional and emotional well-being.”
From Tailored web-based interventions for pain: Systematic review and meta-analysis (2017) · cites this paper as [17]
A systematic review of internet-based CBT for lower back pain reported high effectiveness for pain intensity and disability in 9 RCT studies (n=1796).
“A systematic review of internet-based CBT for lower back pain reported high effectiveness for pain intensity and disability in 9 RCT studies (n=1796) [53].”
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References 24 · Cited by 115
- Authors
- Garg, S., Garg, D., Turin, T. C., & Chowdhury, M. F. U.
- Affiliations
- University of Calgary (CA)
- Corresponding author
- Garg, Shashank
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2016-07-26
- Volume
- 18
- Issue
- 7
- Pages
- e139
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4978860
- OpenAlex
- W2491687544
- Cited by
- 115
- References
- 24
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 5 · 2023: 11 · 2022: 16 · 2021: 16 · 2020: 15 · 2019: 10 · 2018: 11 · 2017: 10 · 2016: 1 · 2015: 1
- FWCI
- 1.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- chronic low back pain, online intervention, internet-based cognitive behavioral therapy, pain catastrophizing, patient empowerment, disability, pain intensity, health care utilization
- MeSH terms
- Humans, Retrospective Studies, Cognitive Behavioral Therapy, Low Back Pain, Internet, Chronic Pain
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