Cited by 121Musculoskeletal pain and rehabilitationDigital Mental Health InterventionsPain Management and Treatment

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Guided internet-based cognitive behavioural treatment for chronic back pain reduces pain catastrophizing: A randomized controlled trial

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Andersson, G, Buhrman, M, Nilsson-Ihrfeldt, E, Jannert, M, Ström, L·2011·Journal of Rehabilitation Medicine

DOI 10.2340/16501977-0805

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Abstract

OBJECTIVE: The aim of this study was to investigate whether an Internet-based cognitive behavioural intervention would have an effect on the symptoms of chronic back pain. DESIGN: Experimental design with a treatment group and a control group measured before and after a treatment period. SUBJECTS: Participants who met the criteria for chronic back pain (n = 54). METHODS: All participants were screened in a live, structured interview before inclusion. The study period was 12 weeks and the treatment consisted of education, cognitive skills acquisition, behavioural rehearsal, generalization and maintenance. The main outcome of interest was the catastrophizing subscale of the Coping Strategies Questionnaire. RESULTS: There were statistically significant reductions from pre- to post-treatment in catastrophizing in the treatment group, and an improvement in quality of life for the treatment group. However, most outcome measures did not indicate a positive treatment outcome. On a scale measuring pain catastrophizing, 58% (15/26) of the treated participants showed reliable improvement, compared with 18% (5/28) of the control group. CONCLUSION: Internet-based cognitive behavioural therapy can serve as a complement for individuals with chronic pain who prefer this treatment and have difficulties accessing specialist treatment facilities.

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Martínez, Ó., Amayra, I., Paz, J. F. L., Lázaro, E., Caballero, P., García, I., Rodríguez, A. A., García, M., Luna, P. M., Pérez-Núñez, P., et al. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.637413 · Cited by 15
“Similarly, this improvement in the levels of QoL is reflected in several studies with various chronic diseases, which use distance learning systems to perform their respective interventions (Shepherd et al., 2006; Macea et al., 2010; Buhrman et al., 2011).”
Background
Implementation of Online Behavior Modification Techniques in the Management of Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis
Cuenca‐Martínez, F., López, L., Suso‐Martí, L., Varangot‐Reille, C., Calatayud, J., Herranz‐Gómez, A., Romero-Palau, M., & Casaña, J. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11071806 · Cited by 15
“…the behavior - Self-monitoring of behavior - Graded tasks 6 weeks 1 call/week Follow-up: 3 months Waiting list N/A N/A N/A N/A Follow-up: 3 months Buhrman et al., 2011 Internet-based Written Email CBT. Physical exercise, relaxation, cognitive skills - Self-monitoring of behavior 8 weeks…”
BackgroundInfluential
Comparing the effects of multimedia and face-to-face pain management education on pain intensity and pain catastrophizing among patients with chronic low back pain: A randomized clinical trial
Shaygan, M., Jaberi, A., Firozian, R., & Yazdani, Z. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269785 · Cited by 14
“A previous study conducted using internet-based education and telephone support reported positive effect in reducing pain catastrophizing among patients with chronic back pain, though researchers reported their inability to have continuous contact with patients throughout the study [44].”
Method
The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis
Sasseville, M., LeBlanc, A., Tchuente, J., Boucher, M., Dugas, M., Mbemba, G. I. C., Barony, R., Chouinard, M., Beaulieu, M., Beaudet, N., et al. (2023) · Systematic Reviews · doi:10.1186/s13643-023-02241-1 · Cited by 16
“Buhrman [36] 2011 Sweden Chronic pain 60 Internet or website Depression/anxiety”
Background
Using Social Media While Waiting in Pain: A Clinical 12-Week Longitudinal Pilot Study
Merolli, M., Gray, K. M., Martin-Sanchez, F. J., Mantopoulos, S., & Hogg, M. (2015) · JMIR Research Protocols · doi:10.2196/resprot.4621 · Cited by 14
“A similar targeted approach has been seen in other pilot studies within a similar study domain [32,36,50].”
Influential
Effectiveness of a Fibromyalgia Online Nursing Consultation in the Quality of Life: A Randomized Controlled Trial
Perea, E. G., Marcos, A. P., Martínez-Rodríguez, S. H., Otones-Reyes, P., & Santos, A. M. P. (2021) · Pain Management Nursing · doi:10.1016/j.pmn.2021.09.001 · Cited by 14
What does coping mean to the worker with pain-related disability? A qualitative study
Carroll, L., Rothe, J. P., & Ozegovic, D. (2012) · Disability and Rehabilitation · doi:10.3109/09638288.2012.723791 · Cited by 13
Effect of a Consumer-Focused Website for Low Back Pain on Health Literacy, Treatment Choices, and Clinical Outcomes: Randomized Controlled Trial
Hodges, P. W., Hall, L., Setchell, J., French, S., Kasza, J., Bennell, K. L., Hunter, D. J., Vicenzino, B., Crofts, S., Dickson, C., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/27860 · Cited by 13
“Refinement of MyBackPain would require assessment because recent evidence highlights inconsistent evidence for the efficacy of web-based cognitive behavioral therapies for LBP [18,19,35,36], interactivity [12], and personalization [36,37].”
Background
A meta‐analytic review of brief guided self‐help education for chronic pain
Liegl, G., Boeckle, M., Leitner, A., & Pieh, C. (2016) · European Journal of Pain · doi:10.1002/ejp.881 · Cited by 12
“…2009; Trautmann and Kr€oner-Herwig, 2010), while nine studies evaluated interventions for adult patients (n = 457; mean age = 42.9 years) (Richardson and McGrath, 1989; Appelbaum et al., 1990; Blanchard et al., 1990; Buhrman et al., 2004, 2011, 2013a,b; Johnston et al., 2010; Dear et al., 2013).”
BackgroundInfluential
Evidence based rehabilitation in chronic pain syndromes
Akyüz, G., & Özkök, Ö. (2012) · Ağrı - The Journal of The Turkish Society of Algology · doi:10.5505/agri.2012.46320 · Cited by 11
“Internet-based cognitive behavioral therapy could serve as a complement for individuals with chronic pain who prefer this treatment and have difficulties accessing specialist treatment facilities.[32] CBT is a new therapeutic approach in the management of CPS, however, more research and people working in this field ar…”
Background
The Effects of a Web-Based Interactive Psycho-Educational Program and a Traditional Psycho-Educational Program Based on Cognitive- Behavioral Approach upon Children’s Cognitive Distortions and Psychological Symptoms
Buğa, A., & Hamamcı, Z. (2016) · Gaziantep University Journal of Social Sciences · doi:10.21547/jss.256702 · Cited by 10
The Effectiveness of Internet-Based Mindfulness Interventions for Physical and Mental Illnesses
Krolikowski, A. (2013) · International Journal of Cyber Behavior Psychology and Learning · doi:10.4018/ijcbpl.2013100106 · Cited by 12
Which Remote Rehabilitation Interventions Work Best for Chronic Musculoskeletal Pain and Depression? A Bayesian Network Meta-Analysis
Bobos, P., Pereira, T., Pouliopoulou, D. V., Charakopoulou-Travlou, M., Nazari, G., & MacDermid, J. C. (2024) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2024.12216 · Cited by 9
Psychological Support for Chronic Low Back Pain: A Systematic Review on the Validity of a Growing Remote Approach
Anselmo, A., Pagano, M. C., Cappadona, I., Cardile, D., Calabrò, R. S., & Corallo, F. (2025) · Current Pain and Headache Reports · doi:10.1007/s11916-024-01340-5 · Cited by 12
Computerized cognitive behaviour therapy for depression in people with a chronic physical illness
Sharp, J., Holly, D., & Broomfield, N. M. (2012) · British Journal of Health Psychology · doi:10.1111/bjhp.12014 · Cited by 9
Pilot study of a basic individualized cognitive behavioral therapy program for chronic pain in Japan
Hosogoshi, H., Iwasa, K., Fukumori, T., Takagishi, Y., Takebayashi, Y., Adachi, T., Oe, Y., Tairako, Y., Takao, Y., Nishie, H., et al. (2020) · BioPsychoSocial Medicine · doi:10.1186/s13030-020-00176-w · Cited by 9
Pain catastrophizing and risk of progression to widespread pain among patients with chronic low back pain: A retrospective cohort study
Licciardone, J. C., Ibrahim, M., Baker, J. F., Thornton, T., & Vu, S. H. (2023) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2023.102886 · Cited by 8
Examining Fidelity of Web-based Acceptance and Commitment Interventions for Women with Chronic Widespread Pain
Nes, A. A. G., Brembo, E. A., van Dulmen, S., Kristjánsdóttir, Ó. B., Wicksell, R. K., & Eide, H. (2015) · The International Journal of Person Centered Medicine · doi:10.5750/ijpcm.v4i2.457 · Cited by 7
Face-to-face telehealth interventions in the treatment of low back pain: A systematic review
Bise, C. G., Cupler, Z. A., Mathers, S., Turner, R. L., Sundaram, M., Catelani, M. B., Daehler, S., Popchak, A., & Schneider, M. (2022) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2022.101671 · Cited by 7
“, 2011 [49] 28 Control 26 Telehealth Control: A waiting where participants were instructed to monitor their pain intensity daily”
Predicting heterogeneous treatment effects of an Internet-based depression intervention for patients with chronic back pain: Secondary analysis of two randomized controlled trials
Harrer, M., Ebert, D. D., Kuper, P. R., Paganini, S., Schlicker, S., Terhorst, Y., Reuter, B., Sander, L., & Baumeister, H. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100634 · Cited by 7
Digital Therapeutics in the Management of Chronic Pain
Rogozinski, B., Greenleaf, W., Sackman, J., & Cahana, A. (2018) · Springer eBooks · doi:10.1007/978-3-319-95369-4_30 · Cited by 7
Les outils numériques au service de l’éducation thérapeutique : leurre ou pertinence ? revue narrative de la littérature
Vitale, E., Genovese, V. V., & Allenet, B. (2021) · Education thérapeutique du patient - Therapeutic patient education · doi:10.1051/tpe/2021007 · Cited by 7
Effectiveness of Telematic Behavioral Techniques to Manage Anxiety, Stress and Depressive Symptoms in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis
Cuenca‐Martínez, F., Suso‐Martí, L., Herranz‐Gómez, A., Varangot‐Reille, C., Calatayud, J., Romero-Palau, M., Blanco‐Díaz, M., Salar-Andreu, C., & Casaña, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063231 · Cited by 6
“4%) diagnosed with chronic back pain [47,52,72,79,80], chronic low back pain [41,55], unspecific chronic pain [43,51,53,56,59,67–71,73–76,81], fibromyalgia [42,46,48,49,58,63,66], headache [44,60,61,78], rheumatic disorders [45,57,62,64], or others [50,54,65].”
BackgroundInfluential
Mechanisms of change in digital cognitive behavioral therapy for depression in patients with chronic back pain: A mediation analysis of a multicenter randomized clinical trial
Lutsch, A., Baumeister, H., Paganini, S., Sander, L., Terhorst, Y., & Domhardt, M. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104369 · Cited by 5
Software‐based interventions for low back pain management: A systematic review and meta‐analysis
Hong, S. J., Park, J. K., Park, S., Eze, B., Dorsey, S. G., Starkweather, A. R., & Kim, K. (2023) · Journal of Nursing Scholarship · doi:10.1111/jnu.12937 · Cited by 5
Cognitive Behavioral Therapy Reduces Unhelpful Thinking Among People with Musculoskeletal Symptoms: A Meta-Analysis
Patel, D. N., Pathapati, R. K., Hand, C., Varma, A., Ramtin, S., & Ring, D. (2024) · Chronic Stress · doi:10.1177/24705470241304252 · Cited by 6
Prevalence of “Red Flags” Among the Internet User with Low Back Pain Seeking Information on Spinal Health—A Web Survey
Miekisiak, G. J., Łątka, D., Sobolewski, T., Sulewski, A., Kubaszewski, Ł., & Kaczmarczyk, J. (2014) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2013.0372 · Cited by 5
“Certain Web applications can serve as a complement for conventional therapy.(8) This is achieved by a range of means, from simple education and reassurance to advanced cognitive behavioral treatment(8,9) and exercise programs.”
Pain‐related catastrophizing: We know it is important but why and how can we change it?
Sharpe, L., & Johnson, A. M. (2012) · European Journal of Pain · doi:10.1002/j.1532-2149.2012.00161.x · Cited by 5
“This is particularly true because there are treatments that have been shown to reduce catastrophizing in pain patients, such as cognitive behavioural therapy (CBT; Buhrman et al., 2011).”
Background
Catastrofización en desórdenes musculoesqueléticos crónicos de mayor prevalencia en Colombia
de Colombia, U. N., Moya, Á. M. G. S., Castro, S. M. B., de Colombia, U. N., Ruíz, J. A. D., & de Colombia, U. N. (2014) · Revista Colombiana de Medicina Física y Rehabilitación · doi:10.28957/rcmfr.v24n2a3 · Cited by 5
Health-related quality of life of women with endometriosis: An Attachment-Diathesis Model of Chronic Pain perspective
Güvenç, İ. B., & Bozo, Ö. (2023) · Health Care For Women International · doi:10.1080/07399332.2023.2177295 · Cited by 4
The Effects of Acceptance and Mindfulness on Catastrophizing, Depression, and Pain in Chronic Pain Patients: The Moderating Effects of Acceptance and Mindfulness
Shin, J., Lee, B.-K., & Lee, H.-K. (2014) · Korean Journal of Stress Research · doi:10.17547/kjsr.2014.22.1.11 · Cited by 3
“만성통증 환자의 재앙적 사고와 같은 부정적인 사고를 개선하는 방법으로 다양한 인지행동치료(Congnitive-beha- vioural therapy: CBT)가 여러 연구(Green et al., 2009; Lamb et al., 2010; Buhrman et al., 2011)에서 시행되어왔고, 이를 통 해 통증과 재앙적 사고를 감소시켰으며 삶의 질이 향상되 었다고 보고하였다.”
Cognitive Behavioral Therapy for Patients with Chronic Musculoskeletal Disorders: A Systematic Review and Meta-analysis
Liu, H.-W., & Tsai, T. (2025) · Cognitive Therapy and Research · doi:10.1007/s10608-025-10686-y · Cited by 2
An Online Mindfulness Intervention for Pain and Wellbeing
Leov, J. (2016) · Otago University Research Archive (University of Otago) · Cited by 2
The impact of technology systems and professional support in digital mental health interventions: a secondary meta-analysisPreprint
Sasseville, M., LeBlanc, A., Tchuente, J., Boucher, M., Dugas, M., Mbemba, G. I. C., Barony, R., Chouinard, M., Beaulieu, M., Beaudet, N., et al. (2021) · medRxiv · doi:10.1101/2021.04.12.21255333 · Cited by 2
“Buhrman(44) 2011 Sweden Chronic pain 60 Internet or website Depression/Anxiety”
Background
Internet-Delivered Cognitive Behavioural Therapy for the Management of Chronic Non-Cancer Pain
CADTH (2022) · Canadian Journal of Health Technologies · doi:10.51731/cjht.2022.462 · Cited by 1
Emotion Regulation in Pain : Developing Effective Interventions for Patients with Pain and Emotional Distress
Södermark, M. (2023) · Linköping University medical dissertations · doi:10.3384/9789180753692 · Cited by 2
Integrating nonpharmacologic strategies for pain with Inclusion, Respect, and Equity (INSPIRE): a digital health study protocol for a pragmatic multisite randomized controlled trial
Ristau, J., Okobi, A., Miller, M. J., Cheng, J., Deviren, S., Schwarz, E. B., Fairchild, T., Tsoh, J. Y., Aguilera, A., Zheng-Huang, C. J., et al. (2026) · Trials · doi:10.1186/s13063-025-09402-8 · Cited by 1

Authors: Andersson, G., Buhrman, M., Nilsson-Ihrfeldt, E., Jannert, M., & Ström, L.
Affiliations: Uppsala University (SE)
ORCID: Andersson, G
Venue: Journal of Rehabilitation Medicine
Publisher: MJS Publishing, Medical Journals Sweden AB
Published: 2011
Volume: 43
Issue: 6
Pages: 500-505
ISSN: 1650-1977 (ISSN-L)
DOI: 10.2340/16501977-0805
OpenAlex: W2044038302
Cited by: 121
References: 24
Citations by year: 2026: 5 · 2025: 3 · 2024: 3 · 2023: 18 · 2022: 10 · 2021: 7 · 2020: 6 · 2019: 5 · 2018: 8 · 2017: 2 · 2016: 10 · 2015: 8 · 2014: 15 · 2013: 9 · 2012: 11
FWCI: 8.40
Type: journal article
Language: en
Open access: gold
doi.org
Locations: Journal of Rehabilitation Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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 back pain, pain catastrophizing, internet-based cognitive behavioral therapy, guided self-help, quality of life, chronic pain
MeSH terms: Adaptation, Psychological, Adult, Aged, Back Pain, Chronic Disease, Female, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Young Adult, Catastrophization

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Guided internet-based cognitive behavioural treatment for chronic back pain reduces pain catastrophizing: A randomized controlled trial

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