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J Psychosom Res. 2019 Mar 26. pii: S0022-3999(19)30055-8. doi: 10.1016/j.jpsychores.2019.03.182. [Epub ahead of print]

Whether chronic pain is medically explained or not does not moderate the response to cognitive-behavioural therapy.

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Department of Psychology, Macquarie University, NSW 2109, Australia. Electronic address:
Department of Health Professions, Macquarie University, NSW 2109, Australia.
Department of Psychology, Macquarie University, NSW 2109, Australia.
Department of Psychology, Macquarie University, NSW 2109, Australia; eCentreClinic, Macquarie University, NSW 2109, Australia.



To determine whether pain-related treatment outcomes, following an online Cognitive Behavioural Therapy (CBT) intervention for chronic pain, were moderated by the pain etiology of a medically explained or unexplained origin.


Data were available from 471 participants who completed the online pain management program between March 2013 and August 2014. Participants' pain symptoms were classified as being medically explained symptoms (MES: n = 292) or medically unexplained symptoms (MUS: n = 222) via analysis of clinical data. Outcome variables were pain-related disability, average pain intensity, depression and anxiety.


Moderation analyses were non-significant for all dependent variables. Between group differences (CBT and control) were larger for depression in those classified with MES, compared with MUS (MUS: mean change = -3.50 [95% CI = -4.98 to -2.22]; MES: mean change = -5.72 [95% CI = -7.49 to -4.09]). However, between group differences were small for pain intensity (MUS: mean change = -0.03 [95% CI = -0.83 to 0.81]; MES: mean difference = -1.12 [95% CI = -1.84 to 0.40]).


The therapeutic outcomes examined in this study associated with an online CBT program do not appear to be altered by whether the participants' pain symptoms are medically explained or unexplained.


Chronic pain; Cognitive behavioural therapy; Etiology; Medically unexplained symptoms; Moderation

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