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      The Pain Course: a randomised controlled trial examining an internet-delivered pain management program when provided with different levels of clinician support

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          Abstract

          This study extends previous research and examined the outcomes of an internet-delivered pain management program when delivered with different levels of clinical support.

          Abstract

          The present study evaluated an internet-delivered pain management program, the Pain Course, when provided with different levels of clinician support. Participants (n = 490) were randomised to 1 of 4 groups: (1) Regular Contact (n = 143), (2) Optional Contact (n = 141), (3) No Contact (n = 131), and (4) a treatment-as-usual Waitlist Control Group (n = 75). The treatment program was based on the principles of cognitive behaviour therapy and comprised 5 internet-delivered lessons provided over 8 weeks. The 3 Treatment Groups reported significant improvements (between-group Cohen's d; avg. reduction) in disability ( ds ≥ 0.50; avg. reduction ≥ 18%), anxiety ( ds ≥ 0.44; avg. reduction ≥ 32%), depression ( ds ≥ 0.73; avg. reduction ≥ 36%), and average pain ( ds ≥ 0.30; avg. reduction ≥ 12%) immediately posttreatment, which were sustained at or further improved to 3-month follow-up. High treatment completion rates and levels of satisfaction were reported, and no marked or consistent differences were observed between the Treatment Groups. The mean clinician time per participant was 67.69 minutes (SD = 33.50), 12.85 minutes (SD = 24.61), and 5.44 minutes (SD = 12.38) for those receiving regular contact, the option of contact, and no clinical contact, respectively. These results highlight the very significant public health potential of carefully designed and administered internet-delivered pain management programs and indicate that these programs can be successfully administered with several levels of clinical support.

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          Most cited references 24

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          Advantages and limitations of Internet-based interventions for common mental disorders.

          Several Internet interventions have been developed and tested for common mental disorders, and the evidence to date shows that these treatments often result in similar outcomes as in face-to-face psychotherapy and that they are cost-effective. In this paper, we first review the pros and cons of how participants in Internet treatment trials have been recruited. We then comment on the assessment procedures often involved in Internet interventions and conclude that, while online questionnaires yield robust results, diagnoses cannot be determined without any contact with the patient. We then review the role of the therapist and conclude that, although treatments including guidance seem to lead to better outcomes than unguided treatments, this guidance can be mainly practical and supportive rather than explicitly therapeutic in orientation. Then we briefly describe the advantages and disadvantages of treatments for mood and anxiety disorders and comment on ways to handle comorbidity often associated with these disorders. Finally we discuss challenges when disseminating Internet interventions. In conclusion, there is now a large body of evidence suggesting that Internet interventions work. Several research questions remain open, including how Internet interventions can be blended with traditional forms of care. Copyright © 2014 World Psychiatric Association.
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            Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance.

            Two studies are presented that investigated 'fear of movement/(re)injury' in chronic musculoskeletal pain and its relation to behavioral performance. The 1st study examines the relation among fear of movement/(re)injury (as measured with the Dutch version of the Tampa Scale for Kinesiophobia (TSK-DV)) (Kori et al. 1990), biographical variables (age, pain duration, gender, use of supportive equipment, compensation status), pain-related variables (pain intensity, pain cognitions, pain coping) and affective distress (fear and depression) in a group of 103 chronic low back pain (CLBP) patients. In the 2nd study, motoric, psychophysiologic and self-report measures of fear are taken from 33 CLBP patients who are exposed to a single and relatively simple movement. Generally, findings demonstrated that the fear of movement/(re)injury is related to gender and compensation status, and more closely to measures of catastrophizing and depression, but in a much lesser degree to pain coping and pain intensity. Furthermore, subjects who report a high degree of fear of movement/(re)injury show more fear and escape/avoidance when exposed to a simple movement. The discussion focuses on the clinical relevance of the construct of fear of movement/(re)injury and research questions that remain to be answered.
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              Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases.

              This paper reports the development of a self-report instrument designed to assess pain in cancer and other diseases. It is argued that issues of reliability and validity should be considered for every pain questionnaire. Most research on measures of pain examine reliability to the relative neglect of validity concerns. The Wisconsin Brief Pain Questionnaire (BPQ) is evaluated with regard to both reliability and validity. Data from patients with cancer at 4 primary sites and from patients with rheumatoid arthritis suggest that the BPQ is sufficiently reliable and valid for research purposes. Additional methodological and theoretical issues related to validity are discussed, and the need for continuing evaluation of the BPQ and other measures of clinical pain is stressed.
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                Author and article information

                Journal
                Pain
                Pain
                JPAIN
                Pain
                JOP
                Pain
                Wolters Kluwer (Philadelphia, PA )
                0304-3959
                1872-6623
                02 June 2015
                October 2015
                : 156
                : 10
                : 1920-1935
                Affiliations
                [a ]eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
                [b ]Departments of Medicine and Psychology, University of Tasmania, Hobart, Australia
                [c ]Australian College of Applied Psychology, Sydney, Australia
                [d ]Department of Psychology, University of Sydney, Sydney, Australia
                [e ]Pain Management Research Institute, Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, Sydney, Australia
                Author notes
                [* ]Corresponding author. Address: Department of Psychology, Macquarie University, Sydney, NSW, Australia. Tel.: +612 9850 9979; fax: +612 9850 8062. E-mail address: blake.dear@ 123456mq.edu.au (B. F. Dear).
                Article
                PAIN-D-14-13464 00012
                10.1097/j.pain.0000000000000251
                4770347
                26039902
                © 2015 International Association for the Study of Pain

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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