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Eur J Pain. 2019 Aug;23(7):1264-1282. doi: 10.1002/ejp.1402. Epub 2019 Jun 13.

An internet-delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomized controlled trial.

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UCD School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin 4, Ireland.
UCD Centre for Translational Pain Research, University College Dublin, Dublin 4, Ireland.
The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland.



Chronic pain is common after spinal cord injury (SCI) and dedicated SCI cognitive behavioural therapy pain management programmes (CBT-PMPs) have a growing evidence base to support their uptake clinically. The development of internet-delivered treatment options may overcome barriers to the access and uptake of centre-based programmes. This study examines such an approach on quality of lie (QoL), pain, mood and sleep.


Adults with SCI pain (>3 months) were recruited and randomly assigned to the intervention or control group. The intervention comprised a six module CBT-PMP delivered once weekly. A blinded assessor determined changes in self-reported outcome measures post-intervention and at 3 months. Linear mixed models and effect sizes based on changes between groups were reported. Significance was set p < 0.05.


The recruitment rate was 32% (intervention n = 35, control n = 34), and the drop-out rate at 3 months was 26%. On average, participants accessed three (SD 2.1) of six modules. While no difference in QoL was reported, a significant group*time interaction was found for NRS of current pain (χ2  = 8.22, p = 0.016), worst pain (χ2  = 11.20, p = 0.004), and Brief Pain Inventory (interference) (χ2  = 6.924, p = 0.031). Moderate to large effect sizes favouring the intervention were demonstrated at each time point for the pain metrics (Cohen's d: 0.38-0.84). At 3-month follow-up, 48% of the intervention group rated themselves improved or very much improved (p < 0.05).


This study demonstrates the potential of an internet-delivered SCI specific CBT-PMP in reporting significant statistical and clinical benefit in pain intensity and interference. Strategies to improve engagement are needed.


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