We developed a Phase 1 research protocol to test the feasibility of a pain management programme delivered online with expert help, and to show how an N of 1 clinical research trial methodology can be used as a better way to conduct a randomised control trial. This was in partnership with 3 NHS Trust sites and has been approved by the UK National Ethics Committee.

The research focusses on collecting both qualitative and quantitative data.

The experts who helped us make a robust research protocol.

Fibromyalgia patients assigned to an internet CBT program reported significantly greater improvements in pain, physical functioning, and overall global improvement.

118 Fibromyalgia patients were randomly assigned to either (a) standard care or (b) standard care plus a Web-Enhanced Behavioural Self-Management program.

Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period.

The Groups that received an internet CBT program reported significant improvements in disability, anxiety (avg. reduction 32%), depression (avg. reduction 36%), and average pain (avg. reduction 12%) immediately post treatment, sustained at or further improved up to a 3-month follow-up.

High treatment completion rates and levels of satisfaction were reported.

Participants (490) were randomised to 1 of 4 groups: (1) Regular Contact (143), (2) Optional Contact (141), (3) No Contact (131), and (4) a treatment-as-usual Waitlist Control Group (75).

The mean clinician time per participant was 67.69 minutes (SD 33.50), 12.85 minutes (SD 24.61), and 5.44 minutes (SD 512.38) for those receiving regular contact, the option of contact, and no clinical contact, respectively.

These results highlight the very significant public health potential of carefully designed and administered internet-delivered pain management programmes and indicate these programmes can be successfully administered with several levels of clinical support.

Guided internet CBT improves pain catastrophizing in Back Pain.

On a scale measuring pain catastrophizing, 58% (15/26) of the treated participants showed reliable improvement, compared with 18% (5/28) of the control group.

Internet-based cognitive behavioural therapy can serve as a complement for individuals with chronic pain specialist treatment facilities.

Combined evidence for 7 well conducted trials of around 6500 patients.

Promising evidence that Internet-based peer support programs can lead to improvements in pain intensity, activity limitation, health distress and self-efficacy.

The efficacy of a distance treatment delivered through Internet and telephone for pediatric recurrent pain.

71 and 72% of the treatment group achieved clinically significant improvement at the 1 and 3-month follow-ups respectively, compared with 19 and 14% of the control group.

Distance methods have considerable potential for making effective treatments more accessible with lower associated costs.

Internet delivered CBT was effective in 48 children, aged 11–17 years, with chronic headache, abdominal, or musculoskeletal pain and associated functional disability.

Significantly greater reduction in activity limitations and pain intensity at post-treatment for the Internet treatment group and these effects were maintained at the three-month follow up.

Rate of clinically significant improvement in pain was also greater for the Internet treatment group compared to the waitlist control group.

Internet treatment was rated as acceptable by all children and parents.

Significant and sustained improvements in clinical outcomes with a clinician guided internet delivered program.

Treatment Group participants obtained significantly greater improvements compared to the Control Group participants in levels of disability, anxiety, depression, and average pain levels at post treatment.

These improvements corresponded to small to large between-groups effect sizes (Cohen’s d) at post treatment for disability (d = .88), anxiety (d = .38), depression (d = .66), and average pain (d = .64), respectively. These outcomes were sustained at follow-up and participants rated the program as highly acceptable.

Overall, the clinician spent a total mean time of 81.54 minutes (SD 30.91 minutes) contacting participants during the program.

Internet delivered CBT works better than internet delivered education for adolescent pain.

Significantly greater reduction on the primary outcome of activity limitations from baseline to 6-month follow-up for Internet CBT compared with Internet education (b 5 21.13, P 5 0.03). On secondary outcomes, significant beneficial effects of Internet CBT were found on sleep quality (b 5 0.14, P 5 0.04), on reducing parent miscarried helping (b 5 22.66, P 5 0.007), protective behaviours (b 5 20.19, P 5 0.001), and on treatment satisfaction (P values , 0.05)

The outcomes of Internet interventions targeting pain were comparable to the outcomes of face-to-face treatments.

Internet based interventions may save therapist time, reduce waiting lists, cut traveling time, and reach populations with health problems who can not easily access other more traditional forms of treatments.