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My pain specialist thinks I should receive CBT but there is no service in my area. The pain clinic offers CBT on the internet, does online CBT work?

There is moderate quality evidence that online CBT teaches people how to reduce pain intensity and other pain-related symptoms.

What is the evidence?


Internet-based cognitive and behavioural interventions vs usual care/wait list/no treatment


No. of


Effect Quality of Evidence
Disability (disruption of life due to pain)35small reduction in disability compared to usual care/wait list/no treatment4 out 35 studies low risk of bias*
Depression28small reduction in depression compared to usual care/wait list/no treatment

4 out of 28 studies low risk of bias*

Anxiety20small reduction in anxiety compared to usual care/wait list/no treatment4 out of 20 studies low risk of bias*
Pain intensity32small reduction in pain intensity compared to usual care/wait list/no treatment4 out of 32 studies low risk of bias*
Pain self-efficacy (confidence in performing activities while in pain)16moderate improvement in pain self-efficacy compared to usual care/wait list/no treatment1 out of 16 studies low risk of bias*
Pain catastrophizing (thoughts and feelings while in pain)15small reduction in pain catastrophizing compared to usual care/wait list/no treatment1 out of 15 studies low risk of bias*

*low risk of bias = low risk the study has method or design errors that would affect the accuracy of the results

What kind of study was this?

This was a systematic review of 36 randomized controlled studies published up to October 2021.

Who? This review included 5,778 adults with chronic pain (pain lasting longert than 3 months) such as back pain, fibromyalgia, migraine, arthritis, neuropathy, spinal cord injury, and pancreatitis.

What? The reviewers included studies that compared internet-based CBT with usual care/wait list/no treatment.

Internet-based CBT


Usual care/Wait List/No treatment

Online modules and lessons that teach people to use the links between their thoughts (attitudes), feelings, and behaviours to manage their pain.

Twenty-five of the online programs included guidance for individual participants delivered by trained psychologists while the rest only received automated feedback (without guided support from a psychologist).

The number of sessions ranged from 6 to 27 and the number of weeks ranged from 3 to 26.

Usual care: medications or other treatments not related to CBT

Wait List: no specific treatment provided while waiting to receive internet-based CBT

Why was this research done?

Cognitive behaviour therapy (CBT) is a type of talking therapy that teaches a person how to manage their pain by thinking and behaving in a more positive way. CBT has been shown to reduce pain, disability, and distress in people with chronic pain. However, accessing psychologists who can provide CBT is a major challenge in some areas. By providing CBT online, the internet could expand the number of people who could benefit from this treatment.

The reviewers wanted to know if internet-delivered CBT reduces pain intensity and other pain-related outcomes in people with chronic pain compared to usual care/wait list/no treatment. They found moderate quality evidence that internet-based CBT reduces pain intensity by a small amount and that it is even better if the online modules include individual guidance from a psychologist. Concerns about this review include the different scores used to measure the outcomes across the studies, and how missing data was handled by the study authors when analyzing the results. It is important to note that this review did not compare internet-based CBT with CBT delivered face-to-face.

This Evidence Summary is based on the following article:

Gandy M, Pang STY, Scott AJ, et al. Internet-delivered cognitive and behavioural based interventions for adults with chronic pain: a systematic review and meta-analysis of randomized controlled trials. Pain. 2022 Feb 7. pii: 00006396-900000000-97782. doi: 10.1097/j.pain.0000000000002606. PubMed

Published: Monday, May 30, 2022
Last Updated: Wednesday, July 27, 2022

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.