Rosser, BA, Fisher, E, Eccleston, C, Duggan, GB and Keogh, E (2021) Psychological therapies delivered remotely for the management of chronic pain (excluding headache) in adults [protocol]. Cochrane Database of Systematic Reviews (1). ISSN 1469-493X

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Abstract

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the efficacy and harms of remotely delivered psychological therapies compared to active control, waiting list, or treatment‐as‐usual for the management of chronic pain in adults. Background Description of the condition: Chronic pain (defined as pain lasting three months or more) is a global public health challenge. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage" (Raja 2020). The prevalence of chronic pain is estimated to be between 20% and 43% globally (Eccleston 2017; Fayaz 2016; Mansfield 2016; Tsang 2008), with annual societal costs per patient estimated at EUR 10,191 (Mayer 2019). Further, the challenge is increasing as the incidence of chronic pain rises in older age (Fayaz 2016; Tsang 2008). The most common types of chronic pain in adults include chronic back pain, fibromyalgia, neuropathic pain, and headache. Chronic pain can be categorised as the disease itself (e.g. fibromyalgia) and is defined as chronic primary pain, or can be associated with or a consequence of an underlying disease (e.g. chronic cancer‐related pain; Treede 2019). The personal consequences of chronic pain may be widespread, disrupting an individual’s ability to engage in everyday life and occupation, affecting social relationships, and deleteriously influencing quality of life (Dueñas 2016; Reid 2011). High levels of depression and anxiety associated with chronic pain may further complicate the emotional impact (Scott 2007). Consequently, chronic pain presents a psychological, as well as physical, challenge. Description of the intervention: Psychological therapies can address the cognitive, behavioural, and emotional factors associated with the experience of chronic pain to support self‐management and the pursuit of personally meaningful goals. These interventions contribute to improvements in mood and pain‐related disability (Williams 2020), and are recognised as an important component of effective pain management treatment (Eccleston 2013; Kerns 2011). However, patients and providers report that access to ‘non‐pharmacological’, often psychological, pain treatments is constrained by multiple barriers, including geographic and economic restrictions (Becker 2017). Consequently, provision of effective and scalable support for chronic pain remains a substantial challenge. Technological advances provide new opportunities for treatment delivery that may overcome traditional barriers and provide support remote from clinician involvement. Technology‐based delivery offers the potential to liberate healthcare expertise from its temporal, geographic, and economic restrictions through partial or complete automation of treatment. Consequently, such delivery methods may increase access to psychological therapeutic support for health conditions such as chronic pain (McGuire 2017). Relevant technologies are multiform and multiplying. Correspondingly, recent reviews emphasise the need to evaluate technology‐based delivery across multiple modalities (Heapy 2015; Slattery 2019). The encouraging support for technology‐based intervention delivery for chronic pain is often tempered by the disproportionate representation of specific modalities (e.g. Internet‐based interventions) within the evidence‐base. However, increasing investigation of technologies such as smartphones is anticipated (McGuire 2017). Consequently, rigorous verification of intervention effectiveness must match rapidly evolving technology. This review is concerned with any technology‐based delivery of psychological therapy for chronic pain that is remote from both the physical presence of the healthcare professional (HCP) and their active involvement. We employ the term ‘remote delivery’ for its superior descriptive capacity to other terms (such as e‐health, telehealth, telemedicine, and digital therapeutics). Fisher and colleagues also employed ‘remote delivery’ in their related review within child and adolescent populations (Fisher 2019), so this enables cross‐review comparison. Eligible interventions will utilise technology as the primary agent of delivering psychological therapy. Technology solely facilitating distance contact between client and clinician (such as videoconferencing) does not fulfil our definition of remote delivery because the intervention, whilst remote from the HCP’s physical presence, remains dependent on their active involvement and direction. We place no restrictions on technology type. How the intervention might work: Psychological therapies comprise multiple modalities with variable intervention targets and therapeutic processes. Existing reviews suggest that psychological therapies have beneficial effects within both adult populations (Williams 2020), and child populations (Fisher 2018). Mainstream psychological approaches supporting individuals experiencing chronic pain typically derive from cognitive and behavioural models of human experience and difficulty (Eccleston 2013; Williams 2020). Traditional cognitive behavioural interventions comprise varying content including psychoeducation, identification and modification of unhelpful patterns of thought and behaviour, and the development and application of coping strategies (Kerns 2011). Whilst content varies, these interventions share an underlying aim to target the interactive relationship between internal experience and external behaviour in order to support personally meaningful engagement with life. Whilst cognitive and behavioural therapies dominate the literature, this review is not limited to any specific therapy modality. Remote delivery of psychological therapy divorces intervention content from face‐to‐face clinician delivery. Technology offers increasingly varied media to achieve this end and facilitate new ways to access psychological interventions for chronic pain (including Internet‐based, smartphone applications, and virtual reality). The potential impact of delivery method should not be underestimated, particularly given the emphasis within psychological interventions on the therapeutic role of client‐clinician relationships (Horvath 2011; Zilcha‐Mano 2017). However, as related reviews suggest, remote delivery also offers additional features beyond those of traditional therapy, which may contribute to the impact of interventions, such as immediate 24‐hour access to support (Fisher 2019), and exact treatment fidelity (Heapy 2015). Consequently, whilst the intervention content and underlying psychological frameworks may appear comparable between traditional and technology‐based delivery, the delivery method has the potential to influence both message and outcome. Why it is important to do this review Traditional face‐to‐face psychological therapies for chronic pain appear useful (Williams 2020). However, access to treatment is restricted by healthcare resources, geography, and cost. Remote technology‐based delivery holds the potential to overcome these traditional treatment barriers. However, therapeutic equivalence between traditional and technology‐based delivery requires substantiation. Further, communication technology provides opportunities for content and delivery that outstrip what is possible face to face, and may facilitate novel interventions (Eccleston 2018). Whilst previous reviews of Internet‐based psychological interventions for chronic pain are encouraging (Bender 2011; Buhrman 2016; Eccleston 2014), evolving technologies necessitate the need to consider a broader spectrum of technologies capable of remote delivery. Concern remains that technological innovation, such as smartphone applications, is outpacing regulation and evidential support, despite repeat criticism (Lalloo 2015; Portelli 2016; Rosser 2011). Consequently, a review enabling aggregation and evaluation of remote delivery ‐ via multiple technologies ‐ of psychological therapy for chronic pain is warranted. Fisher 2019 provides such a review of remotely delivered psychological interventions for chronic pain in children and adolescents. Williams 2020 provides a review of face‐to‐face psychological interventions in adults with chronic pain. We aim to complement both reviews by conducting a review of psychological interventions delivered remote from the therapist for adults with chronic pain. This review will update and supersede our previous review focused on Internet‐delivered psychological therapies (Eccleston 2014).

Item Type:	Article
Additional Information:	This is the peer reviewed version of the following article: Rosser BA, Fisher E, Eccleston C, Duggan GB, Keogh E. Psychological therapies delivered remotely for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD013863, which has been published in final form at https://dx.doi.org/10.1002/14651858.cd013863. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Uncontrolled Keywords:	1102 Cardiorespiratory Medicine and Haematology, 1107 Immunology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > R Medicine (General)
Divisions:	Psychology (from Sep 2019)
Publisher:	Wiley
Date Deposited:	15 Mar 2021 11:35
Last Modified:	28 Jan 2022 00:50
DOI or ID number:	10.1002/14651858.cd013863
URI:	https://researchonline.ljmu.ac.uk/id/eprint/14607

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