Internet-Delivered Cognitive Behavioural Therapy for the Management of Chronic Non-Cancer Pain
Bibliographic record
Abstract
This Health Technology Assessment (HTA) was conducted to inform decision-makers about whether internet-delivered cognitive behavioural therapy (iCBT) should be offered as a treatment option for chronic non-cancer pain as part of a multidisciplinary approach when in-person cognitive behavioural therapy (CBT) would otherwise be offered. This HTA consists of a systematic review of clinical effectiveness and safety, an interview study, and an Environmental Scan. In this HTA, iCBT is defined as psychotherapy based on CBT principles delivered through the internet, including self-directed app-based programs (with or without therapist support) and CBT delivered through the internet in real time by a therapist (e.g., videoconference). The Clinical Review found there was little to no difference between iCBT and in-person CBT for most outcomes, but the evidence was very uncertain because of risk of bias, inconsistency, indirectness, and imprecision. The uncertain clinical evidence prevents a strong conclusion about the safety and effectiveness of iCBT as a treatment option when in-person CBT would otherwise be offered for chronic non-cancer pain. Five women living with chronic non-cancer pain were interviewed regarding their experiences with, or perspectives on, the use of iCBT for chronic pain. All the women interviewed felt iCBT has the potential to be a supportive treatment option if offered as part of comprehensive, multidisciplinary pain care. Based on their experiences, the women interviewed reported that multidisciplinary pain care does not always happen in practice, and they described potential concerns of offering iCBT in the absence of other treatments. They also indicated that determining a patient’s readiness for iCBT is important. If iCBT is determined to be appropriate, the women emphasized that a tailored treatment approach and a strong therapeutic relationship between the patient and iCBT provider might improve the success of iCBT treatment for chronic pain. The Environmental Scan identified 16 iCBT programs for chronic pain that are available in Canada. Many potential facilitators (e.g., improving access, improving treatment experience, efficiency, and convenience) and barriers (preference for in-person treatment, privacy concerns, technology issues, and no access to a device or internet connection) for iCBT programs in Canada were identified. If decision-makers decide to implement an iCBT program for chronic pain as part of their multidisciplinary pain care approach, they may wish to consider offering programs that: are guided by therapists specifically trained in chronic pain foster strong therapeutic relationships, encourage shared decision-making practices, and can be tailored to the needs of the person living with chronic pain consider the readiness and suitability of the person living with chronic pain before offering iCBT consider privacy and technological concerns or challenges.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".