A randomized controlled trial of an Internet-based cognitive-behavioural intervention for non-specific chronic pain: an effectiveness and cost-effectiveness study.
BACKGROUND
Cognitive-behavioural treatment can nowadays be delivered through the Internet. This form of treatment can have various advantages with regard to availability and accessibility. Previous studies showed that Internet-based treatment for chronic pain is effective compared to waiting-list control groups.


METHODS
We conducted a randomized controlled trial comparing an Internet-based cognitive-behavioural intervention with e-mail therapist contact to a face-to-face cognitive-behavioural group intervention. Of the 72 participants who were randomly assigned to an Internet or a group course, 50 participants completed the intervention. Participants were assessed at baseline (T0), immediately after the 7-week course (T1) and at the booster session 2 months later (T2). Pain-related catastrophizing was the primary outcome measure. Pain intensity, fatigue, pain-related interference, locus of control, pain coping, global health-related quality of life and medical expenses were secondary outcome variables.


RESULTS
Significant improvement was found on catastrophizing, pain coping, locus of control and aspects of global health-related quality of life in both the Internet and the group courses directly after the course and at the booster session. Pain intensity was improved in both courses at the booster session. At T2, improvement in catastrophizing, pain intensity, pain coping and some quality of life dimensions was significantly greater in completers of the Internet course than in the group course. Furthermore, the Internet course was cost-effective compared to the group course.


CONCLUSIONS
We conclude that the Internet-based cognitive-behavioural intervention was at least as effective as the face-to-face group intervention and, on some outcome measures appeared to be even more effective.
Pain Center, Department of Anesthesiology, University of Groningen, University Medical Center Groningen, The Netherlands.
M J
MJ
de Boer
G J
GJ
Versteegen
K M
KM
Vermeulen
R
R
Sanderman
M M R F
MM
Struys
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D058443:Catastrophization / Q000191:economics / Q000523:psychology / Q000628:therapy*; D059350:Chronic Pain / Q000191:economics / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007389:Internal-External Control; D020407:Internet; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011615:Psychotherapy, Group / Q000191:economics / Q000379:methods; D011788:Quality of Life; D013813:Therapy, Computer-Assisted / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult