JMIR Publications

ABSTRACT

Background:

Background:

Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated.

Objective:

Objective:

This study aimed to examine the effectiveness of an integrated cognitive behavioral program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing.

Methods:

Methods:

We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy sessions with treatment as usual. Thirty patients (22–75 years old) with chronic pain were randomly assigned to either videoconference-based cognitive behavioral therapy (n = 15) or treatment as usual (n = 15). Patients were evaluated at weeks 1 (baseline), 8 (mid-intervention), and 16 (post-intervention). The primary outcome was the change in pain intensity, which was recorded using the Numerical Rating Scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed by the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost-utility.

Results:

Results:

In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the two groups in terms of changes in pain intensity by Numerical Rating Scale scores at week 16 from baseline (p = 0.357), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (-1.43 [95% CI -2.49 to -0.37], df = 24, p = 0.010). Further, significant improvement was seen in pain interference by BPI (-9.42 [95% CI -14.47 to -4.36], df = 25, p = 0.001) and disability by the Pain Disability Assessment Scale (-1.95 [95% CI -3.33 to -0.56], df = 24, p = 0.008) compared with treatment as usual. As for Medical Economic Evaluation, the incremental cost-effectiveness ratio for one year was estimated at 2.9 million yen per quality-adjusted life year gained (JPY/QALY =96,000; JPY divided by 0.033 QALY).

Conclusions:

Our results suggested integrated cognitive behavioral therapy delivered by videoconferencing on the regular medical care may be reduced in pain interference although pain intensity was not changed. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. Clinical Trial: Trial Registration: University Hospital Medical Information Network: UMIN000031124.