Online teletherapy for chronic pain: A systematic review

Abstract

Objective A systematic review designed to evaluate the benefits of remote group pain management for persons with chronic pain was performed. Methods PubMed, EMBASE and PsychINFO databases were searched in April 2019. Eligible studies evaluated teletherapy for chronic pain based on set inclusion and exclusion criteria. Two reviewers independently screened eligible studies, assessed risk of bias and extracted data. Each study design was rated and study quality was assessed using an 11-point scale of methodological quality. Results Comprehensive searches identified 12 studies that met all inclusion/exclusion criteria and each study was assessed for type of technology, study design, outcome measures, study findings and limitations. No published studies investigated synchronous teletherapy for groups of chronic pain patients. Methods of assessment varied considerably across studies. Strength of evidence was moderate and many of the selected studies had issues with treatment compliance/adherence and selection bias. Teletherapy strategies for persons with chronic pain were shown to improve pain, mood, disability and catastrophising, however half of the studies selected did not meet the criteria for acceptable standards for internal validity. Those trials with limited therapist involvement appeared to be less beneficial and tended to report lower adherence than those which had higher levels of therapist guidance or peer support. Conclusions Preliminary findings suggest that teletherapy and remote online cognitive behavioural therapy strategies can be effective in improving quality of life among persons with chronic pain, although the overall quality of evidence is moderate. Controlled trials are needed to assess live remote teletherapy for chronic pain.

Cross-sectional study of psychosocial and pain-related variables among patients with chronic pain during a time of social distancing imposed by the coronavirus disease 2019 pandemic

“…There has been an increased demand and recommendation to use remotely supported eHealth pain management services with the outbreak, which brings unique changes in service delivery of pain management. 18 , 25 A recent systematic review found that teletherapy and remote online cognitive behavioral therapy (CBT) strategies can be effective in improving quality of life among persons with chronic pain, 41 with 1 study suggesting that online group CBT may be as effective in improving coping among persons with chronic pain as in-person groups. 42 Such findings are promising, although additional research is needed to evaluate the impact of eHealth while recognizing the unique challenges created by the pandemic.…”

The social threats of COVID-19 for people with chronic pain

“…45,46 Online pain management programs seem to hold promise, 29 particularly when patients have contact with healthcare providers, albeit remotely. 54 Online resources can disseminate pain education, and online training programs on pain self-management can be developed for healthcare professionals, those with pain, and their close others. 30,41,84 However, these novel digital interventions might not be accessible for all and may even put up new barriers to those who require them the most (eg, socially disconnected individuals with limited digital literacy).…”

Management of Intractable Pain in Patients With Implanted Spinal Cord Stimulation Devices During the COVID-19 Pandemic Using a Remote and Wireless Programming System

“…In most pain management settings, telemedicine has been used in the form of video consultation, which mainly focuses on complaints that can be orally solved, such as palliative care and self-management skills. Some reviews have identified small to moderate reductions in pain, disability, and psychological symptoms in intervention groups applying telemedicine when compared with the control (including standard pain care or waitlist control) (Buhrman et al, 2016;Mariano et al, 2019). However, no therapeutic difference was found when compared to the active control (such as on-site therapies) (Mariano et al, 2019).…”

“…Some reviews have identified small to moderate reductions in pain, disability, and psychological symptoms in intervention groups applying telemedicine when compared with the control (including standard pain care or waitlist control) (Buhrman et al, 2016;Mariano et al, 2019). However, no therapeutic difference was found when compared to the active control (such as on-site therapies) (Mariano et al, 2019). Remotely delivered physical exercise interventions have also been proposed to reduce pain in patients as a substitute for the usual care (Adamse et al, 2018).…”