Research Center for Child Mental Development, Chiba University, Chiba, Japan.
Department of Psychology, Teikyo University, Hachioji, Japan.
J Med Internet Res. 2021 Nov 22;23(11):e30690. doi: 10.2196/30690.
Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated.
This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing.
This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility.
In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (-1.43, 95% CI -2.49 to -0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (-9.42, 95% CI -14.47 to -4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (-1.95, 95% CI -3.33 to -0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained.
The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size.
University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb.
认知行为疗法已被证明可改善慢性疼痛的管理。然而，这种疗法的组成部分仍在研究和讨论中。
本研究旨在检验一种新的整合认知行为疗法（注意力转移、记忆训练、视频反馈和图像训练）的有效性，该疗法通过视频会议进行。
该研究为一项慢性疼痛的随机对照试验，将 30 名年龄在 22-75 岁之间的慢性疼痛患者随机分为每周 16 次视频会议的认知行为疗法（vCBT）组（n=15）和常规治疗（TAU）组（n=15）。患者在第 1 周（基线）、第 8 周（中期干预）和第 16 周（干预后）接受评估。主要结局指标是疼痛强度的变化，在基线后 16 周使用数字评分量表进行评估。次要结局指标包括疼痛严重程度和疼痛干扰、残疾、疼痛灾难化认知、抑郁、焦虑、生活质量和成本效用。
在资格评估中，最终有 30 名患者被随机分配并纳入研究，最终 vCBT 组有 15 名患者，TAU 组有 14 名患者接受了分析。尽管两组在基线后第 16 周数字评分量表评估的疼痛强度变化方面无显著差异（P=.36），但简明疼痛量表总评分评估的疼痛综合情况有显著改善（-1.43，95%CI-2.49 至-0.37，df=24；P=.01）。此外，简明疼痛量表评估的疼痛干扰（-9.42，95%CI-14.47 至-4.36，df=25；P=.001）和疼痛残疾评估量表评估的残疾（-1.95，95%CI-3.33 至-0.56，df=24；P=.008）与 TAU 相比均有显著改善。对于医疗经济评估，1 年的增量成本效益比估计为每获得 1 个质量调整生命年需花费 290 万日元（约合 25000 美元）。
本研究结果表明，在常规医疗护理中通过视频会议进行的整合认知行为疗法可能会降低疼痛干扰，但不会降低疼痛强度。此外，这种治疗方法可能具有成本效益，但需要使用更大的样本量进一步验证。
日本大学医院医疗信息网络 UMIN000031124；https://tinyurl.com/2pr3xszb。
