N09 Pain management in inflammatory bowel disease: feasibility of an online therapist-supported CBT-self-management intervention

Abstract

Abstract Background Chronic pain is a poorly managed symptom of inflammatory bowel disease (IBD). Cognitive behavioural therapy (CBT) has an evidence-base in functional gastrointestinal conditions and chronic pain. We aimed to test the feasibility and acceptability of a 9-week online facilitator-supported CBT intervention, tailored for people with chronic IBD-related pain. Methods A single arm pre-post design with nested qualitative interviews was used with 20 individuals with IBD and chronic pain. Participants were recruited online through an IBD charity and had consented to research in a previous survey or responded to an online charity advert. Individuals who met the inclusion criteria e.g. reported a pain-interference score of ≥4/10 (Brief Pain Inventory) and had no indicators of acute causes of pain, were invited to take part. Faecal calprotectin was collected. Outcomes included recruitment and retention rates, pain interference and severity (Brief Pain Inventory), quality of life, psychosocial measures and self-reported disease activity (IBD-Control). Follow-up face to face or telephone interviews were conducted following the intervention to obtain feedback on sessions and tasks, facilitator support and areas for improvement. Results Of 145 survey respondents contacted, 55 (37.9%) responded. Two additional individuals were recruited from the study advertisement. 20/57 (35.1%) met screening and eligibility criteria. Twenty consented to the study and 60% of those returning a stool sample were in clinical remission (<250ug/g). One individual withdrew after Session 1, 17 (85%) engaged with intervention sessions and 11 (55%) completed at least 5/9 sessions. 16 (80%) of recruited participants completed the post-intervention questionnaire at week 9. Mean score for overall acceptability was 43.4 (0–70). No changes were observed for pain outcomes, but quality of life and pain self-efficacy increased following the intervention. Self-reported disease activity, depression, anxiety, pain catastrophising and avoidance resting behaviour decreased. Qualitative feedback demonstrated the value of particular elements of the intervention, such as thought monitoring and facilitator support. Some participants felt content was oversimplified and that further information was needed on practical management strategies, including diet. Conclusion Online CBT for chronic IBD-related pain appears feasible and acceptable. The results demonstrate positive effects for improving quality of life and reducing psychological distress, however online and face to face recruitment methods are recommended. To establish efficacy for reducing pain and improving quality of life, larger randomised controlled trials are required.