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

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

The Clinical Journal of Pain: May 2015 - Volume 31 - Issue 5 - p 404–413
doi: 10.1097/AJP.0000000000000125
Original Articles

Objectives: Little is known about the moderators and mediators of change in online pain interventions based on cognitive-behavior 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 with 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.

*Inflexxion Inc., Newton, MA

University of Texas Health Science Center, San Antonio, TX

The preparation of this manuscript was funded by SBIR Grant # 5R44AR061191-03, awarded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD. The authors declare no conflict of interest.

Reprints: Kimberlee J. Trudeau, PhD, Inflexxion Inc., 320 Needham Street, Suite 100, Newton, MA 02464 (e-mail:

Received October 1, 2013

Received in revised form July 9, 2014

Accepted May 30, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.