title: Mediators and moderators of chronic pain outcomes in an online self-management program.
abstract: OBJECTIVE
  Little is known about the moderators and mediators of change in online pain interventions based on cognitive-behavior therapy (CBT). We hypothesized that the effects of painACTION.com, an online pain self-management program, on pain-related outcomes would be mediated by changes in depression, anxiety, and stress, as well as the use of coping strategies. We also examined potential moderators of change.
  
  
  METHODS
  First, the efficacy of painACTION.com and moderators of the intervention effects were evaluated using a pooled sample from previous back, neuropathic, and arthritis pain studies. Next, we explored whether the intervention effect on the primary outcomes, pain severity, and patient global impression of change (PGIC), was mediated by coping strategies or emotional functioning.
  
  
  RESULTS
  Compared with controls, experimental participants evidenced significant improvement in pain, emotional functioning, and coping strategies from baseline to follow-up. There were no clear moderators of intervention effects. Changes in emotional factors, particularly stress levels, mediated the relationship between the intervention and outcome (pain severity) over time.
  
  
  CONCLUSIONS
  This study supports the effectiveness of online interventions when CBT and self-management targets pain levels, emotional factors, and wellness-focused coping. The importance of stress as a mediator of pain severity is discussed. The absence of moderators may indicate that the intervention is effective for a wide variety of patients with chronic pain.
authors.affiliation: *Inflexxion Inc., Newton, MA †University of Texas Health Science Center, San Antonio, TX.
authors.forename: Pronabesh
authors.initials: P
authors.lastname: DasMahapatra
authors.forename: Emil
authors.initials: E
authors.lastname: Chiauzzi
authors.forename: Lynette M
authors.initials: LM
authors.lastname: Pujol
authors.forename: Cristina
authors.initials: C
authors.lastname: Los
authors.forename: Kimberlee J
authors.initials: KJ
authors.lastname: Trudeau
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms / Q000209:etiology* / Q000534:rehabilitation*; D059350:Chronic Pain / Q000150:complications / Q000523:psychology / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012648:Self Care; D016896:Treatment Outcome