The Efficacy of Web-Based Cognitive Behavioral Interventions for Chronic Pain: A Systematic Review and Meta-Analysis

  • Debora Duarte Macea
    Laboratory of Neuromodulation, Physical Medicine and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts

    Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Krzysztof Gajos
    School of Engineering and Applied Sciences Health, Harvard University, Boston, Massachusetts
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  • Yasser Armynd Daglia Calil
    School of Public Health Harvard University, Boston, Massachusetts
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  • Felipe Fregni
    Address reprint requests to F. Fregni, MD, PhD, 125 Nashua Street, 7th floor, Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Boston, MA 02114-1198.
    Laboratory of Neuromodulation, Physical Medicine and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts

    Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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      Our objective was to conduct a systematic review and meta-analysis to quantify the efficacy of web-based cognitive behavioral interventions for the treatment of patients with chronic pain. MEDLINE and other databases were searched as data sources. Reference lists were examined for other relevant articles. We included 11 studies that evaluated the effects of web-based interventions on chronic pain using specific scales of pain. The pooled effect size (standardized mean difference between intervention versus waiting-list group means) from a random effects model was .285 (95% confidence interval: .145–.424), favoring the web-based intervention compared with the waiting-list group, although the effect was small. In addition, these results were not driven by any particular study, as shown by sensitivity analysis. Results from funnel plot argue against publication bias. Finally, the average dropout rate was 26.6%. In our meta-analysis, we demonstrate a small effect of web-based interventions, when using pain scale as the main outcome. Despite the minor effects and high dropout rates, the decreased costs and minor risk of adverse effects compared with pharmacological treatments support additional studies in chronic pain patients using web-based interventions. Further studies will be important to confirm the effects and determine the best responders to this intervention.


      Our findings suggest that web-based interventions for chronic pain result in small pain reductions in the intervention group compared with waiting-list control groups. These results advance the field of web-based cognitive behavioral interventions as a potential therapeutic tool for chronic pain and can potentially help clinicians and patients with chronic pain by decreasing treatment costs and side effects.

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