The Timing and Magnitude of Improvements in Depression, Anxiety, Disability, and Pain Intensity During an Internet-delivered Program for Chronic Pain.

Numerous studies have found that pain management programs are an effective treatment option for people with chronic pain. However, little is known about when people experience improvements during these programs and why they are effective. Using a secondary analysis, the current study examined the timing and magnitude of symptom change during an 8-week internet-delivered psychological pain management program for people with chronic pain. The change in 4 outcomes was examined: depression (n = 881), anxiety (n = 561), disability (n = 484), and pain intensity (n = 484). The largest improvements in depression, anxiety, and disability were reported during the first half of treatment (ie, 4 weeks), whereas the largest reductions in pain intensity were reported during the second half of treatment. Half the participants had experienced a clinically meaningful improvement in depression or anxiety, and a third of participants had reported such an improvement in disability by midtreatment (ie, 5 weeks after baseline). In a subgroup analysis (n = 397), this pattern of change in depression and anxiety symptoms did not differ based on the level of therapist guidance. This study highlights the importance of the first few weeks of psychological pain management programs and encourages future work to examine how the mechanisms underpinning rapid change may be harnessed to optimize care for people with chronic pain. PERSPECTIVE: This study found that depression, anxiety, and disability improved rapidly during the first half of an 8-week internet-delivered pain management program, and most of the prepost change had occurred by midtreatment. This work highlights the therapeutic potential of the first few treatment sessions and prompts future research into a rapid responding.

Can Internet-Delivered Pain Management Programs Reduce Psychological Distress in Chronic Pain? Exploring Relationships Between Anxiety and Depression, Pain Intensity, and Disability.

BACKGROUND: Adults with chronic pain who also report high pain intensity and disability are more likely to experience depression and anxiety symptoms. The present study examined changes in anxiety and depression symptoms after an Internet-delivered pain management program based on baseline pain intensity and disability severity categories. METHODS: We conducted a secondary analysis of data from four randomized controlled trials (N = 1,333). RESULTS: Greater pain intensity and disability were associated with increased odds of elevated anxiety or depression symptoms at baseline. Treatment led to greater reductions in anxiety and depression symptoms compared with a waitlist control, and these improvements occurred irrespective of baseline pain intensity or disability severity. Those individuals who reported ≥30% improvements in pain intensity or disability after treatment were more likely to also report ≥30% improvements in psychological symptoms. Importantly, most participants who achieved ≥30% improvements in depression and anxiety had not experienced such improvements in pain intensity or disability. CONCLUSION: These findings suggest that emerging Internet-delivered pain management programs can lead to reductions in psychological distress even when pain intensity and disability are severe or do not improve with treatment. This indicates the value of such treatments in treating distress and improving mental health in people with chronic pain.

Perceived barriers and facilitators to healthy eating and physical activity in endoscopic bariatric patients: a qualitative study.

PURPOSE: To explore the perceived barriers and facilitators to healthy eating and physical activity in individuals opting for endoscopic bariatric procedures. METHODS: A total of 55 participants were recruited from a metropolitan bariatric clinic in Australia. Participants were interviewed at one of two stages of treatment: pre-procedure (n = 34) or 5-6 months post-procedure (n = 18). Interviews were transcribed and analyzed using content analysis. RESULTS: Five themes emerged from analysis of participant responses in both groups including lifestyle, psychological, physiological, social, and eating behaviors. Each theme consisted of subthemes which were either perceived barriers, or facilitators, to healthy eating and physical activity. Perceived barriers consisted of factors such as time constraints, low motivation, unhealthy habits and portion control, low priority of personal health, emotional difficulties, and pain/mobility issues. Facilitators included subthemes such as planning/organization, high motivation, seeing results, improved self-esteem, increased energy, improved mobility, and changing mindset about portions. CONCLUSION: The results highlight the importance of delivering individualized and targeted treatment plans for individuals opting for bariatric procedures. LEVEL OF EVIDENCE: Level III: Evidence obtained from cohort or case-control analytic studies.