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Individualized Guided Internet-delivered Cognitive-Behavior Therapy for Chronic Pain Patients With Comorbid Depression and Anxiety

A Randomized Controlled Trial

Buhrman, Monica PhD*; Syk, Martin MSc*; Burvall, Olle MSc*; Hartig, Terry PhD*; Gordh, Torsten MD, PhD; Andersson, Gerhard PhD‡,§

The Clinical Journal of Pain: June 2015 - Volume 31 - Issue 6 - p 504–516
doi: 10.1097/AJP.0000000000000176
Special Topics Series

Objectives: Depression and anxiety are commonly seen in patients with chronic pain which affects the patient’s daily life functioning. Although considerable attention has been devoted to explain why depression and anxiety are frequent comorbid with chronic pain, little empirical work has been conducted on interventions that target depression and anxiety and chronic pain. The present study was designed to test an individualized cognitive-behavioral treatment delivered through the internet for persons with chronic pain and emotional distress.

Materials and Methods: A total of 52 patients with chronic pain and depression were included and randomized to either treatment for 8 weeks or to a control group that participated in a moderated online discussion forum.

Results: Intent-to-treat analyses showed significant decreases regarding depressive symptoms and pain disability in the treatment group. Results on the primary outcomes of depression and anxiety were in favor of the treatment group. Reductions were also found on pain catastrophizing.

Discussion: One-year follow-up showed maintenance of improvements. We conclude that an individualized guided internet-delivered treatment based on cognitive-behavior therapy can be effective for persons with chronic pain comorbid emotional distress.

*Department of Psychology

Pain Research, Department of Surgical Sciences, Uppsala University

Department of Behavioural Sciences and Learning, Linköping University, Linköping University

§Psychiatry Section, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

The authors declare no conflict of interest.

Reprints: Monica Buhrman, PhD, Department of Psychology, Box 1225, 754 41 Uppsala, Sweden (e-mail:

Received July 15, 2014

Received in revised form November 26, 2014

Accepted October 22, 2014

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