Sudden gains in depression and anxiety during an online pain management programme for chronic pain

IF 3.5 2区医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-05-12 DOI:10.1002/ejp.2280

Madelyne A. Bisby, Ashleigh B. Correa, Rachel Trujillo, Joanne Dudeney, Blake F. Dear

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Abstract

Background

Chronic pain is associated with depression and anxiety symptoms. Pain management programms, delivered face-to-face or via the internet, can effectively help adults manage the impacts of chronic pain. Sudden gains are defined as substantial, rapid, and lasting symptom reductions that occur between consecutive treatment sessions and have been associated with better treatment outcomes in non-pain samples. This study examined whether adults with chronic pain report sudden gains in depression or anxiety symptoms during an 8-week online pain management programme, and whether sudden gains were associated with better treatment outcomes for depression or anxiety. Dominant theories of sudden gains argue that therapists are required for sudden gains to be maintained and improve treatment outcomes.

Methods

Using data from a published randomized controlled trial (n = 338), sudden gains and treatment outcomes were compared across three levels of therapist guidance provided alongside the programme: weekly, optional, and self-guided.

Results

Similar rates of sudden gains were observed in depression (22%) and anxiety (24%) across the treatment period, and most sudden gains occurred between Weeks 1 and 2 of treatment. Therapist guidance was not associated with sudden gains; higher baseline symptom severity emerged as the only consistent predictor of sudden gain status. No significant differences in treatment outcomes for depression or anxiety symptoms between sudden gainers and non-gainers were observed across therapist guidance conditions.

Conclusions

These results do not support an association between sudden gains in depression or anxiety symptoms and better post-treatment outcomes, at least for adults with chronic pain.

Significance Statement

Sudden gains in depression and anxiety symptoms were not associated with improved treatment outcomes for adults with chronic pain who participated in an online pain management programme, regardless of the level of therapist guidance provided. These findings suggest possible differences in symptom change in chronic pain samples compared to general population samples.

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在针对慢性疼痛的在线疼痛管理项目中，抑郁和焦虑情绪突然加重。

背景：慢性疼痛与抑郁和焦虑症状有关：慢性疼痛与抑郁和焦虑症状有关。面对面或通过互联网提供的疼痛管理计划可有效帮助成年人控制慢性疼痛的影响。突发性增益的定义是在连续治疗过程中出现的大量、快速和持久的症状减轻，在非疼痛样本中与更好的治疗效果相关。本研究考察了患有慢性疼痛的成年人在为期 8 周的在线疼痛管理项目中是否会出现抑郁或焦虑症状的突发性改善，以及突发性改善是否与抑郁或焦虑的更好治疗效果相关。突发性增益的主流理论认为，突发性增益需要治疗师来维持并改善治疗效果：方法：利用已发表的随机对照试验（n = 338）的数据，对治疗师在提供方案的同时提供的三种指导水平（每周指导、可选指导和自我指导）的突发性增益和治疗效果进行了比较：结果：在整个治疗期间，抑郁症（22%）和焦虑症（24%）的突然增益率相似，大多数突然增益发生在治疗的第 1 周和第 2 周。治疗师的指导与突发性增益无关；基线症状严重程度较高是突发性增益的唯一一致预测因素。在不同的治疗师指导条件下，突然增益者与未增益者在抑郁或焦虑症状的治疗结果上没有明显差异：这些结果并不支持抑郁或焦虑症状的突然改善与更好的治疗后结果之间的关联，至少对患有慢性疼痛的成年人而言是如此：无论治疗师提供的指导水平如何，抑郁和焦虑症状的突然改善与参与在线疼痛管理项目的慢性疼痛成人治疗效果的改善无关。这些发现表明，与普通人群样本相比，慢性疼痛样本的症状变化可能存在差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.