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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000125
Original Article: PDF Only

Mediators and Moderators of Chronic Pain Outcomes in an Online Self-Management Program.

DasMahapatra, Pronabesh MD, MPH; Chiauzzi, Emil PhD; Pujol, Lynette Menefee PhD; Los, Cristina BS; Trudeau, Kimberlee J. PhD

Published Ahead-of-Print
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Objectives: Little is known about the moderators and mediators of change in online pain interventions based on cognitive behavioral therapy (CBT). We hypothesized that the effects of, an online pain self- management program, on pain-related outcomes would be mediated by changes in depression, anxiety, and stress, as well as the use of coping strategies. We also examined potential moderators of change.

Methods: First, the efficacy of and moderators of the intervention effects were evaluated using a pooled sample from previous back, neuropathic, and arthritis pain studies. Next, we explored whether the intervention effect on the primary outcomes - pain severity and patient global impression of change (PGIC) was mediated by coping strategies or emotional functioning.

Results: Compared to controls, experimental participants evidenced significant improvement in pain, emotional functioning, and coping strategies from baseline to follow-up. There were no clear moderators of intervention effects. Changes in emotional factors, particularly stress levels, mediated the relationship between the intervention and outcome (pain severity) over time.

Discussion: This study supports the effectiveness of online interventions when CBT and self-management targets pain levels, emotional factors and wellness-focused coping. The importance of stress as a mediator of pain severity is discussed. The absence of moderators may indicate that the intervention is effective for a wide variety of patients with chronic pain.

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