The purpose of this pilot randomized controlled trial was to examine the feasibility of an internet delivered, self-directed mindfulness-based cognitive therapy (iMBCT) program compared to a delayed treatment (DT) control. This trial employed a 2-group parallel (1:1), design and was pre-registered (ANZCTR Identifier: 12623000833662). Participants were N = 48 adults with chronic pain, randomized into either the 4-week iMBCT program or the DT control. The feasibility indicators were treatment engagement, study retention, treatment acceptability, and at least a small within-condition pre- to post-treatment effect size change in pain intensity or interference. The primary outcome was change in pain intensity, and secondary outcomes were pain interference, depression, sleep disturbance, and positive and negative affect at post-treatment/DT (primary endpoint). A high degree of engagement with iMBCT was found, with participants reporting it acceptable and of benefit; retention rate (88%) was high. Within iMBCT, a small-to-medium effect size improvement in pain interference (p =.031, d = 0.48) was found, and change in pain intensity was small (p =.347, d =.20). Small-to-medium changes were found for the other secondary outcomes within iMBCT. Small-to-less than small effect sizes were observed within DT. These preliminary findings indicate iMBCT is a feasible, tolerable, and acceptable treatment for chronic pain, and may result in meaningful improvements in pain interference. Taken together, the results suggest iMBCT may have the capacity to overcome access barriers and provide individuals with chronic pain a much needed, evidence-based treatment to enhance pain self-management. PERSPECTIVE: This article presents the feasibility findings of an internet delivered, self-directed mindfulness-based cognitive therapy for chronic pain program. This novel digital platform may represent a scalable solution to increase access to critically needed chronic pain management services.
| Discipline Area | Score |
|---|---|
| Psychologist |  |
| Physician |  |
Physician rater
The effectiveness of internet-delivered psychological therapies for people with chronic pain has been extensively studied. This small 4-week study with mindfulness-based cognitive therapy and people with different chronic non-cancer pain syndromes adds no new information to the existing knowledge. The study has some major weaknesses. There was no "fair" control group (delayed treatment). There was no statistical comparison of the treatment group with the control group. Internet-delivered psychological therapies with a longer duration and tailored to the psychological features (e.g., catastrophizing, unresolved emotional conflicts) of people with defined chronic pain syndromes (e.g., only neuropathic pain or only fibromyalgia) are needed.
Psychologist rater
The results suggest iMBCT led to a small decrease in pain interference, but no significant change in pain intensity. This suggests patients may be better able to tolerate their pain after treatment. For a short internet-based treatment, this is clearly a positive outcome.
Psychologist rater
This is an extremely relevant finding that serves to support long-held theoretical notions that this style of intervention could/would be effective. My compliments to the authors.
Psychologist rater
This article provides evidence for the feasibility and effectiveness of online delivery of an important treatment. It would have been helpful to compare against in-person delivery to ensure there is no loss of impact.
, McMaster University