Terpstra Jessy A, van der Vaart Rosalie, van Beugen Sylvia, van Eersel Roxy A, Gkika Ioanna, Erdős Dorottya, Schmidt Jana, Radstake Caroline, Kloppenburg Margreet, van Middendorp Henriët, Evers Andrea W M
Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands.
Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands.
Internet Interv. 2022 Nov 10;30:100587. doi: 10.1016/j.invent.2022.100587. eCollection 2022 Dec.
Chronic pain has a large individual and societal burden. Previous reviews have shown that internet-based cognitive-behavioral therapy (iCBT) can support patients' pain coping. However, factors related to participant experience of iCBT and effective and safe iCBT delivery for chronic pain have not recently been summarized.
The aim of this review was to give an overview of the efficacy of guided iCBT for chronic pain on psychological, physical, and impact on daily life outcomes, including factors that inform optimal delivery.
Cochrane, Emcare, Web of Science, PubMed, PsycINFO, and Embase were systematically searched from inception to 11 February 2022. Randomized controlled trials on guided iCBTs for adults with chronic pain were included with a broad range of outcomes.
The search yielded 7406 studies of which 33 studies were included totaling 5133 participants. ICBT was more effective than passive control conditions for psychological (ES = 0.34-0.47), physical (ES = 0.26-0.29), and impact outcomes (ES = 0.38-0.41). ICBT was more effective than active control conditions for distress (ES = 0.40), pain acceptance (ES = 0.15), and pain interference after outlier removal (ES = 0.30). Longer treatments were associated with larger effects for anxiety and quality of life than shorter treatments. Mode of therapist contact (synchronous, asynchronous or a mix of both) was not related to differences in effect sizes in most outcomes. However, studies with mixed and synchronous contact modes had higher effects on pain self-efficacy than studies with asynchronous contact modes. Treatment satisfaction was high and adverse events were minor. Dropout was related to time, health, technical issues, and lack of computer skills.
Guided iCBT is an effective and potentially safe treatment for chronic pain. Future research should more consistently report on iCBT safety and detail the effectiveness of individual treatment components to optimize iCBT in clinical practice.
慢性疼痛给个人和社会带来了沉重负担。以往的综述表明，基于互联网的认知行为疗法（iCBT）可以帮助患者应对疼痛。然而，最近尚未总结与iCBT参与者体验相关的因素以及慢性疼痛有效且安全的iCBT实施方式。
本综述旨在概述指导性iCBT对慢性疼痛在心理、身体以及对日常生活结果方面的疗效，包括有助于优化实施的因素。
从数据库建立至2022年2月11日，系统检索了Cochrane、Emcare、科学网、PubMed、PsycINFO和Embase。纳入了针对患有慢性疼痛的成年人的指导性iCBT随机对照试验，并涵盖了广泛的结果。
检索共得到7406项研究，其中33项研究被纳入，总计5133名参与者。在心理（效应量=0.34-0.47）、身体（效应量=0.26-0.29）和影响结果（效应量=0.38-0.41）方面，iCBT比被动对照条件更有效。在去除异常值后，iCBT在痛苦（效应量=0.40）、疼痛接纳（效应量=0.15）和疼痛干扰方面比主动对照条件更有效（效应量=0.30）。与较短疗程相比，较长疗程对焦虑和生活质量的影响更大。在大多数结果中，治疗师联系模式（同步、异步或两者混合）与效应量差异无关。然而，与异步联系模式的研究相比，混合和同步联系模式的研究对疼痛自我效能的影响更大。治疗满意度高，不良事件轻微。退出与时间、健康、技术问题和缺乏计算机技能有关。
指导性iCBT是一种治疗慢性疼痛的有效且潜在安全的方法。未来的研究应更一致地报告iCBT的安全性，并详细说明个体治疗成分的有效性，以在临床实践中优化iCBT。
