An internet-delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomized controlled trial.

Abstract

Chronic pain is common after spinal cord injury (SCI) and dedicated SCI cognitive behavioural therapy pain management programmes (CBT-PMPs) have a growing evidence base to support their uptake clinically. The development of internet-delivered treatment options may overcome barriers to the access and uptake of centre-based programmes. This study examines such an approach on quality of lie (QoL), pain, mood and sleep. Adults with SCI pain (>3months) were recruited and randomly assigned to the intervention or control group. The intervention comprised a six module CBT-PMP delivered once weekly. A blinded assessor determined changes in self-reported outcome measures post-intervention and at 3months. Linear mixed models and effect sizes based on changes between groups were reported. Significance was set p<0.05. The recruitment rate was 32% (intervention n=35, control n=34), and the drop-out rate at 3months was 26%. On average, participants accessed three (SD 2.1) of six modules. While no difference in QoL was reported, a significant group*time interaction was found for NRS of current pain (χ2 =8.22, p=0.016), worst pain (χ2 =11.20, p=0.004), and Brief Pain Inventory (interference) (χ2 =6.924, p=0.031). Moderate to large effect sizes favouring the intervention were demonstrated at each time point for the pain metrics (Cohen's d: 0.38-0.84). At 3-month follow-up, 48% of the intervention group rated themselves improved or very much improved (p < 0.05). This study demonstrates the potential of an internet-delivered SCI specific CBT-PMP in reporting significant statistical and clinical benefit in pain intensity and interference. Strategies to improve engagement are needed.