Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 4:11:1715-1728.
doi: 10.2147/JPR.S157939. eCollection 2018.

Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study

Nina Bendelin  1 , Björn Gerdle  1 , Gerhard Andersson  2   3
Affiliations

Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study

Nina Bendelin et al. J Pain Res. .

Abstract

Purpose: Methods for delivering aftercare to help chronic pain patients to continue practice self-management skills after rehabilitation are needed. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to partly fill this gap given its accessibility and emphasis on self-care. Methods for engaging and motivating patients to persist throughout the full length of treatment are needed. The aim of this study was to describe how chronic pain patients work in an ICBT program, through their descriptions of what is important when they initiate behavior change in aftercare and their descriptions of what is important for ongoing practice of self-management skills in aftercare.

Patients and methods: Following a multimodal rehabilitation program, 29 chronic pain patients participated in a 20-week-long Internet-delivered aftercare program (ACP) based on acceptance-based cognitive behavioral therapy. Latent content analysis was made on 138 chapters of diary-like texts written by participants in aftercare.

Results: Attitudes regarding pain and body changed during ACP, as did attitudes toward self and the future for some participants. How participants practiced self-management skills was influenced by how they expressed motivation behind treatment goals. Whether they practiced acceptance strategies influenced their continuous self-management practice. Defusion techniques seemed to be helpful in the process of goal setting. Mindfulness strategies seemed to be helpful when setbacks occurred.

Conclusion: Self-motivating goals are described as important both to initiate and in the ongoing practice of self-management skills. Experiencing a helpful effect of acceptance strategies seems to encourage participants to handle obstacles in new ways and to persist throughout treatment. Research on whether tailored therapist guidance might be helpful in stating self-motivating goals and contribute to ongoing practice of self-management skills is needed.

Keywords: Internet-delivered cognitive-behavioral therapy; acceptance and commitment therapy; chronic pain; qualitative analysis; self-management.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of inclusion procedure. Abbreviation: MMRP, multimodal rehabilitation program.
Figure 2
Figure 2
Summary of result: central themes, aspects of motivation, and used therapeutic interventions. Abbreviation: ACP, aftercare program.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Gerdle B, Molander P, Stenberg G, Stålnacke BM, Enthoven P. Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain – a practice based evidence study from two SQRP centres. BMC Musculoskelet Disord. 2016;17(1):1–14. - PMC - PubMed
    1. Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012;11:CD007407. - PMC - PubMed
    1. Eccleston C, Morley SJ, Williams AC. Psychological approaches to chronic pain management: evidence and challenges. Br J Anaesth. 2013;111(1):59–63. - PubMed
    1. Hann KEJ, McCracken LM. A systematic review of randomized controlled trials of acceptance and commitment therapy for adults with chronic pain: outcome domains, design quality, and efficacy. J Contextual Behav Sci. 2014;3(4):217–227.
    1. Turk DC, Rudy TE. Neglected topics in the treatment of chronic pain patients – relapse, noncompliance, and adherence enhancement. Pain. 1991;44(1):5–28. - PubMed