Online treatment can reduce effects of chronic pain, shows study

Research is showing a free online program for people with chronic pain can reduce how much the pain affects them and improve their overall quality of life—and the effects are long lasting.

Chronic pain affects 1 in 5 Australians, with about a quarter of those reporting that pain has a serious impact on their day-to-day lives.

Common causes of chronic include arthritis, back and neck pain, migraine, serious injury, cancer, and illnesses such as endometriosis and fibromyalgia. Ongoing pain can result in depression, anxiety, social isolation, loss of income and relationship breakdown.

Cognitive behavioral therapy (CBT) has proved effective in dealing with a range of conditions including chronic pain, teaching people how to alter unhelpful patterns of thinking and behavior.

Traditionally delivered face-to-face by therapists, online options have become more common in recent years.

Macquarie University Professor of Psychology and Senior Clinical Psychologist, Professor Blake Dear, developed the Pain Course delivered by the University's free online mental health service, MindSpot Clinic.

Professor Dear and his colleagues have been refining it and assessing its effectiveness over the past 10 years.

The latest evaluation was a five-year trial with 1,367 patients who used the program at the MindSpot clinic, a service available to all Australian adults. All the previous research had been conducted in a specialist research clinic.

Three-quarters of participants completed the program, and 82% of those said they were either satisfied or very satisfied with the outcome.

The people who took part reported improvements in all areas measured, including a 26% improvement in symptoms of depression, a 24% improvement in anxiety, a 13% improvement in pain intensity, and a 19% improvement in pain-related disability.

They also said they felt more confident of being able to function while in pain, and less likely to worry that their pain was a sign that doctors had missed something. The study is published in the journal Pain Medicine.

Not a straightforward problem

Professor Dear says chronic pain is not a psychological phenomenon.

"The tricky and intriguing thing about it is that pain is an emergent experience, and how it affects us can be unpredictable," he says.

"We receive input from our nervous system that results in pain, but how we experience that pain is also affected by how we are feeling in terms of low mood, depression, sadness, stress or anxiety.

"When someone has been in pain for a long time, has had a flare-up, or their pain has become worse for some reason, that affects many aspects of their life, which in turn creates stress and pressure that enhances or complicates the experience.

"Pain also gets in the way of us looking after ourselves and doing the things that help to keep us mentally well, like exercising or spending time with friends or family.

"Living with chronic pain can have an enormous impact, but it is possible for people to learn skills to manage that impact on their day-to-day activities and their mental health.

"The main target with the MindSpot chronic pain course is to assist people to do the things that are important to them in their lives and minimize the impact of pain on their mental health, and our latest trial shows that it can do that."

How the pain course works

Taught using evidence-based online modules, the MindSpot chronic pain course is delivered with the option of weekly support from therapists via telephone and secure messaging systems.

Before starting the course, participants are assessed to ensure that it is suitable for them. If they have experienced a major change in their pain recently, they should make sure to see a doctor to rule out anything that needs medical attention.

During the course, participants learn about chronic pain and the nervous system, all the factors that have an effect on pain, and develop a basic understanding of how their pain is impacting them.

The hope is that people will use that to understand their own experience and get a map of the difficulties they're having.

Participants learn a range of skills to use to manage their pain, like thought management, being mindful of the thoughts they're having during a bout of pain, and making sure those thoughts are accurate and helpful.

The research is also suggesting the results are long-lasting.

"Participants are still reporting ongoing positive outcomes when we followed up with them three months after finishing treatment, and at the 12-month and two-year marks," Professor Dear says.

"Once people have a good understanding of their pain, and have developed a good set of skills to deal with it, they are able to manage over the long term. It's really encouraging.

"One of the good things about these internet-delivered courses is that they're very accessible, and have the potential to increase access to care programs like the Pain Course.

"This is a huge consideration at a time when we have seen an increase in demand for care and a shortage of psychologists, who often help people to manage the impacts of chronic pain."