Why was this research done?

Chronic musculoskeletal pain can affect physical, emotional, and social well-being. Cognitive behavioural therapy (CBT) can help some people manage chronic pain, but access to in-person CBT may be limited by factors such as cost, travel, scheduling, and the availability of trained therapists. Self-guided online CBT programs may provide another way for people to learn pain coping skills. The researchers wanted to know whether adding the PainTRAINER online CBT program to duloxetine would improve pain more than duloxetine alone. They also wanted to know whether brief motivational interviewing by phone would encourage people to use the program more and improve their outcomes.

After 24 weeks, adding PainTRAINER did not provide additional improvement in overall pain, pain intensity, or pain interference compared with duloxetine alone. Phone support also did not increase completion of PainTRAINER or improve pain outcomes. This means the study does not show that CBT in general is ineffective for chronic pain; it tells us that offering this particular self-guided program alongside duloxetine did not provide additional pain relief in this study.

There are some important limitations. Everyone in the study received duloxetine, so this study cannot tell us how well duloxetine works compared with no duloxetine or placebo. It also only included people who were able to tolerate duloxetine during the initial one-week period. Finally, just under half of participants using PainTRAINER completed at least six of its eight modules, so it remains uncertain whether the results would have been different if more participants had completed the program.

Although this study did not find that adding PainTRAINER improved pain overall, an earlier study of a related online program called PainCOACH, in which 91% of participants completed all eight modules, found improvements in some pain-related outcomes. In the current study, participants who completed more modules also reported less pain, although this does not prove that greater use of the program caused better outcomes. Taken together, these findings leave some uncertainty about the effectiveness of online pain coping programs when participants engage more fully with them.