Zusammenfassung
Hintergrund: Personen mit Schmerzsymptomen leiden häufig unter komorbider Depression. Die Gate-Control-Theorie nimmt an, dass die Schmerzwahrnehmung durch psychosoziale Einflüsse moduliert wird und dass die Linderung von Depressionen entsprechend auch Schmerzen verringern kann. Da Schmerzpatienten oft immobil sind und die psychotherapeutische Versorgung unzureichend ist, stellen Online-Interventionen eine vielversprechende Alternativbehandlung dar. Die vorliegende randomisiert-kontrollierte Studie untersucht die Wirksamkeit der Online-Intervention novego – Depressionen bewältigen bei Schmerzpatienten mit depressiven Symptomen. Patienten und Methoden: Von den re-krutierten Teilnehmern mit Schmerzen und depressiven Symptomen wurden je 71 Personen randomisiert der Interventionsgruppe oder der Wartekontrollgruppe zugeteilt. Der Interventionszeitraum betrug 12 Wochen. Zum Baseline- und Postzeitpunkt wurden depressive (BDI-II; primärer Endpunktparameter) sowie Schmerzsymptome (VAS, DSF; sekundäre Endpunktparameter) erfasst. Ergebnisse: Die Teilnehmer der novego-Gruppe zeigten einen signifikanten Rückgang im BDI-II mit einer kleinen bis mittleren Effektgröße von ηp2 = 0,043 in der Intention-to-treat-Analyse und ηp2 = 0,057 in der Per-protocol-Analyse. Die Schmerzsymptome gingen in beiden Gruppen gleichermaßen ohne signifikante Unterschiede zurück. Explorative Moderationsanalysen zeigten jedoch, dass Patienten mit Schmerzen in den Händen oder im oberen Rücken signifikant von novego bezüglich der Schmerzsymptomatik profitierten. Die Zufriedenheit mit der Intervention war hoch. Schlussfolgerung: Die Online-Intervention novego ist geeignet, um depressive Symptome bei Teilnehmern mit unterschiedlicher Schmerz-symptomatik zu reduzieren. Patienten mit Schmerzen in den Händen oder im oberen Rücken können besonders davon profitieren.
Literatur
1.
Andersson
G
, Hesser
H
, Veilord
A
, Svedling
L
, Andersson
F
, Sleman
O
, et al. Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression
. J Affect Disord
. 2013
Dec
;151
(3
):986
–94
.
[PubMed]
0165-03272.
Baumeister
H
, Reichler
L
, Munzinger
M
, Lin
J
. The impact of guidance on Internet-based mental health interventions— A systematic review
. Internet Interv
. 2014
;1
(4
):205
–15
. 2214-78293.
Beck
AT
, Steer
RA
, Brown
GK
. Beck Depression Inventory.
Second Edition.Manual, San Antonio, TX, The Psychological Corporation, 1996
.4.
Beiwinkel
T
, Eißing
T
, Telle
NT
, Siegmund-Schultze
E
, Rössler
W
. Effectiveness of a Web-Based Intervention in Reducing Depression and Sickness Absence: Randomized Controlled Trial
. J Med Internet Res
. 2017
Jun
;19
(6
):e213
.
[PubMed]
1438-88715.
Bender
JL
, Radhakrishnan
A
, Diorio
C
, Englesakis
M
, Jadad
AR
. Can pain be managed through the Internet? A systematic review of randomized controlled trials
. Pain
. 2011
Aug
;152
(8
):1740
–50
.
[PubMed]
0304-39596.
Berger
T
, Hämmerli
K
, Gubser
N
, Andersson
G
, Caspar
F
. Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help
. Cogn Behav Ther
. 2011
;40
(4
):251
–66
.
[PubMed]
1650-60737.
Berman
RL
, Iris
MA
, Bode
R
, Drengenberg
C
. The effectiveness of an online mind-body intervention for older adults with chronic pain
. J Pain
. 2009
Jan
;10
(1
):68
–79
.
[PubMed]
1526-59008.
Borkovec
TD
, Nau
SD
. Credibility of analogue therapy rationales
. J Behav Ther Exp Psychiatry
. 1972
;3
(4
):257
–60
. 0005-79169.
Borm
GF
, Fransen
J
, Lemmens
WA
. A simple sample size formula for analysis of covariance in randomized clinical trials
. J Clin Epidemiol
. 2007
Dec
;60
(12
):1234
–8
.
[PubMed]
0895-435610.
Bower
P
, Kontopantelis
E
, Sutton
A
, Kendrick
T
, Richards
DA
, Gilbody
S
, et al. Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data
. BMJ
. 2013
Feb
;346
feb26 2
:f540
.
[PubMed]
0959-813811.
Breivik
H
, Collett
B
, Ventafridda
V
, Cohen
R
, Gallacher
D
. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment
. Eur J Pain
. 2006
May
;10
(4
):287
–333
.
[PubMed]
1090-380112.
Bücker
L
, Bierbrodt
J
, Hand
I
, Wittekind
C
, Moritz
S
. Effects of a depression-focused internet intervention in slot machine gamblers: A randomized controlled trial
. PLoS One
. 2018
Jun
;13
(6
):e0198859
.
[PubMed]
1932-620313.
Buhrman
M
, Gordh
T
, Andersson
G
. Internet interventions for chronic pain including headache: A systematic review
. Internet Interv
. 2016
Jan
;4
:17
–34
.
[PubMed]
2214-782914.
Byrne
BM
, Stewart
SM
, Kennard
BD
, Lee
PW
. The Beck Depression Inventory-II: testing for measurement equivalence and factor mean differences across Hong Kong and American adolescents
. Int J Test
. 2007
;7
(3
):293
–309
. 1530-505815.
Carlbring
P
, Andersson
G
, Cuijpers
P
, Riper
H
, Hedman-Lagerlöf
E
. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis
. Cogn Behav Ther
. 2018
Jan
;47
(1
):1
–18
.
[PubMed]
1650-607316.
Casser
HR
, Hüppe
M
, Kohlmann
T
, Korb
J
, Lindena
G
, Maier
C
, et al. Deutscher Schmerzfragebogen (DSF) und standardisierte Dokumentation mit KEDOQ-Schmerz. Auf dem Weg zur gemeinsamen Qualitätsentwicklung der Schmerztherapie
. Schmerz
. 2012
Apr
;26
(2
):168
–75
.
[PubMed]
0932-433X17.
Clement
S
, Schauman
O
, Graham
T
, Maggioni
F
, Evans-Lacko
S
, Bezborodovs
N
, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies
. Psychol Med
. 2015
Jan
;45
(1
):11
–27
.
[PubMed]
0033-291718.
Crofford
LJ
. Psychological aspects of chronic musculoskeletal pain
. Best Pract Res Clin Rheumatol
. 2015
Feb
;29
(1
):147
–55
.
[PubMed]
1521-694219.
Cuijpers
P
, van Straten
A
, Andersson
G
. Internet-administered cognitive behavior therapy for health problems: a systematic review
. J Behav Med
. 2008
Apr
;31
(2
):169
–77
.
[PubMed]
0160-771520.
Devilly
GJ
, Borkovec
TD
. Psychometric properties of the credibility/expectancy questionnaire
. J Behav Ther Exp Psychiatry
. 2000
Jun
;31
(2
):73
–86
.
[PubMed]
0005-791621.
Dozois
DJ
, Westra
HA
, Collins
KA
, Fung
TS
, Garry
JK
. Stages of change in anxiety: psychometric properties of the University of Rhode Island Change Assessment (URICA) scale
. Behav Res Ther
. 2004
Jun
;42
(6
):711
–29
.
[PubMed]
0005-796722.
Dueñas
M
, Ojeda
B
, Salazar
A
, Mico
JA
, Failde
I
. A review of chronic pain impact on patients, their social environment and the health care system
. J Pain Res
. 2016
Jun
;9
:457
–67
.
[PubMed]
1178-709023.
Eccleston
C
, Fisher
E
, Craig
L
, Duggan
GB
, Rosser
BA
, Keogh
E
. Psychological therapies (Internet-delivered) for the management of chronic pain in adults
. Cochrane Database Syst Rev
. 2014
Feb
;(2
):CD010152
.
[PubMed]
1469-493X24.
Eccleston
C
, Williams
AC
, Morley
S
. Psychological therapies for the management of chronic pain (excluding headache) in adults
. Cochrane Database Syst Rev
. 2009
Apr
;(2
):CD007407
.
[PubMed]
1469-493X25.
García-Batista
ZE
, Guerra-Peña
K
, Cano-Vindel
A
, Herrera-Martínez
SX
, Medrano
LA
. Validity and reliability of the Beck Depression Inventory (BDI-II) in general and hospital population of Dominican Republic
. PLoS One
. 2018
Jun
;13
(6
):e0199750
.
[PubMed]
1932-620326.
Garg
S
, Garg
D
, Turin
TC
, Chowdhury
MF
. Web-Based Interventions for Chronic Back Pain: A Systematic Review
. J Med Internet Res
. 2016
Jul
;18
(7
):e139
.
[PubMed]
1438-887127.
Gerbershagen
HU
, Korb
J
, Nagel
B
, Nilges
P
. Das Mainzer Stadiensystem der Schmerzchronifizierung - Mainz Pain Staging System (MPSS)
. Mainz
: DRK-Schmerzzentrum
; 1986
.28.
Gerrits
MM
, van Oppen
P
, van Marwijk
HW
, Penninx
BW
, van der Horst
HE
. Pain and the onset of depressive and anxiety disorders
. Pain
. 2014
Jan
;155
(1
):53
–9
.
[PubMed]
0304-395929.
Goesling
J
, Clauw
DJ
, Hassett
AL
. Pain and depression: an integrative review of neurobiological and psychological factors
. Curr Psychiatry Rep
. 2013
Dec
;15
(12
):421
.
[PubMed]
1523-381230.
Gräfe
K
, Zipfel
S
, Herzog
W
, Löwe
B
. Screening psychischer Störungen mit dem „ Gesundheitsfragebogen für Patienten (PHQ-D)“
. Diagnostica
. 2004
;50
(4
):171
–81
. 0012-192431.
Hasler
G
, Klaghofer
R
, Buddeberg
C
. Der Fragebogen zur Erfassung der Veränderungsbereitschaft (FEVER) - Testung der deutschen Version der University of Rhode Island Change Assessment Scale (URICA) -
. Psychother Psychosom Med Psychol
. 2003
Sep-Oct
;53
(9-10
):406
–11
.
[PubMed]
0937-203232.
Johansson
R
, Andersson
G
. Internet-based psychological treatments for depression
. Expert Rev Neurother
. 2012
Jul
;12
(7
):861
–9
.
[PubMed]
1473-717533.
Karyotaki
E
, Riper
H
, Twisk
J
, Hoogendoorn
A
, Kleiboer
A
, Mira
A
, et al. Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data
. JAMA Psychiatry
. 2017
Apr
;74
(4
):351
–9
.
[PubMed]
2168-622X34.
Kerns
RD
, Turk
DC
. Depression and Chronic Pain: The Mediating Role of the Spouse
. J Marriage Fam
. 1984
;46
(4
):845
. 0022-244535.
Klein
JP
, Berger
T
, Schröder
J
, Späth
C
, Meyer
B
, Caspar
F
, et al. Effects of a psychological internet intervention in the treatment of mild to moderate depressive symptoms: results of the evident study, a randomized controlled trial
. Psychother Psychosom
. 2016
;85
(4
):218
–28
.
[PubMed]
0033-319036.
Kroenke
K
, Spitzer
RL
, Williams
JB
. The PHQ-9: validity of a brief depression severity measure
. J Gen Intern Med
. 2001
Sep
;16
(9
):606
–13
.
[PubMed]
0884-873437.
Lal
S
, Adair
CE
. E-mental health: a rapid review of the literature
. Psychiatr Serv
. 2014
Jan
;65
(1
):24
–32
.
[PubMed]
1075-273038.
Larsen
DL
, Attkisson
CC
, Hargreaves
WA
, Nguyen
TD
. Assessment of client/patient satisfaction: development of a general scale
. Eval Program Plann
. 1979
;2
(3
):197
–207
.
[PubMed]
0149-718939.
Lopez
MN
, Pierce
RS
, Gardner
RD
, Hanson
RW
. Standardized Beck Depression Inventory-II scores for male veterans coping with chronic pain
. Psychol Serv
. 2013
May
;10
(2
):257
–63
.
[PubMed]
1541-155940.
Lyden
JR
, Zickmund
SL
, Bhargava
TD
, Bryce
CL
, Conroy
MB
, Fischer
GS
, et al. Implementing health information technology in a patient-centered manner: patient experiences with an online evidence-based lifestyle intervention
. J Healthc Qual
. 2013
Sep-Oct
;35
(5
):47
–57
.
[PubMed]
1062-255141.
Macea
DD
, Gajos
K
, Daglia Calil
YA
, Fregni
F
. The efficacy of Web-based cognitive behavioral interventions for chronic pain: a systematic review and meta-analysis
. J Pain
. 2010
Oct
;11
(10
):917
–29
.
[PubMed]
1526-590042.
McConnaughy
EA
, Prochaska
JO
, Velicer
WF
. Stages of change in psychotherapy: measurement and sample profiles
. Psychotherapy
. 1983
;20
(3
):368
–75
. 0033-320443.
Melzack
R
, Wall
PD
: Pain Mechanisms: A New Theory
. 1965
;150:971–979. 44.
Moritz
S
, Schröder
J
, Klein
JP
, Lincoln
TM
, Andreou
C
, Fischer
A
, et al. Effects of online intervention for depression on mood and positive symptoms in schizophrenia
. Schizophr Res
. 2016
Aug
;175
(1-3
):216
–22
.
[PubMed]
0920-996445.
Nagel
B
, Gerbershagen
HU
, Lindena
G
, Pfingsten
M
. Entwicklung und empirische Uberprüfung des Deutschen Schmerzfragebogens der DGSS
. Schmerz
. 2002
Aug
;16
(4
):263
–70
.
[PubMed]
0932-433X46.
Newman
MG
, Szkodny
LE
, Llera
SJ
, Przeworski
A
. A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy?
Clin Psychol Rev
. 2011
Feb
;31
(1
):89
–103
.
[PubMed]
0272-735847.
Poleshuck
EL
, Talbot
NL
, Su
H
, Tu
X
, Chaudron
L
, Gamble
S
, et al. Pain as a predictor of depression treatment outcomes in women with childhood sexual abuse
. Compr Psychiatry
. 2009
May-Jun
;50
(3
):215
–20
.
[PubMed]
0010-440X48.
Poole
H
, Bramwell
R
, Murphy
P
. Factor Structure of the Beck Depression Inventory-II in patients With chronic pain
. Clin J Pain
. 2006
Nov-Dec
;22
(9
):790
–8
.
[PubMed]
0749-804749.
Poole
H
, White
S
, Blake
C
, Murphy
P
, Bramwell
R
. Depression in chronic pain patients: prevalence and measurement
. Pain Pract
. 2009
May-Jun
;9
(3
):173
–80
.
[PubMed]
1530-708550.
Richards
D
, Richardson
T
. Computer-based psychological treatments for depression: a systematic review and meta-analysis
. Clin Psychol Rev
. 2012
Jun
;32
(4
):329
–42
.
[PubMed]
0272-735851.
Roditi
D
, Robinson
ME
. The role of psychological interventions in the management of patients with chronic pain
. Psychol Res Behav Manag
. 2011
;4
:41
–9
.
[PubMed]
1179-157852.
Schmidt
J
, Lamprecht
F
, Wittmann
WW
. Zufriedenheit mit der stationären Versorgung. Entwicklung eines Fragebogens und erste Validitätsuntersuchungen
. Psychother Psychosom Med Psychol
. 1989
Jul
;39
(7
):248
–55
.
[PubMed]
0937-203253.
Schröder
J
, Berger
T
, Westermann
S
, Klein
JP
, Moritz
S
: Internet interventions for depression: new developments. [Internet]. . Dialogues Clin Neurosci 2016
[cited 2018 Nov 1];18:203–12.54.
Sherman
JJ
, Turk
DC
, Okifuji
A
: Prevalence and impact of posttraumatic stress disorder-like symptoms on patients with fibromyalgia syndrome. [Internet]. . Clin J Pain 2000
[cited 2018 Nov 1];16:127–34.55.
Simon
LS
. RELIEVING PAIN IN AMERICA: A BLUEPRINT FOR TRANSFORMING PREVENTION, CARE, EDUCATION, AND RESEARCH
. J Pain Palliat Care Pharmacother
. 2012
;26
(2
):197
–8
. 1536-028856.
Spek
V
, Nyklícek
I
, Smits
N
, Cuijpers
P
, Riper
H
, Keyzer
J
, et al. Internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old: a randomized controlled clinical trial
. Psychol Med
. 2007
Dec
;37
(12
):1797
–806
.
[PubMed]
0033-291757.
Subica
AM
, Fowler
JC
, Elhai
JD
, Frueh
BC
, Sharp
C
, Kelly
EL
, et al. Factor structure and diagnostic validity of the Beck Depression Inventory-II with adult clinical inpatients: comparison to a gold-standard diagnostic interview
. Psychol Assess
. 2014
Dec
;26
(4
):1106
–15
.
[PubMed]
1040-359058.
Tracey
I
, Bushnell
MC
. How neuroimaging studies have challenged us to rethink: is chronic pain a disease?
J Pain
. 2009
Nov
;10
(11
):1113
–20
.
[PubMed]
1526-590059.
Turk
DC
, Salovey
P
: "Chronic pain as a variant of depressive disease
". A critical reappraisal. [Internet]. . J Nerv Ment Dis 1984
[cited 2019 Feb 17];172:398–404. 60.
Vickers
AJ
, Altman
DG
. Statistics notes: analysing controlled trials with baseline and follow up measurements
. BMJ
. 2001
Nov
;323
(7321
):1123
–4
.
[PubMed]
0959-813861.
Von Korff
M
, Ormel
J
, Keefe
FJ
, Dworkin
SF
. Grading the severity of chronic pain
. Pain
. 1992
Aug
;50
(2
):133
–49
.
[PubMed]
0304-395962.
Wetherell
JL
, Afari
N
, Rutledge
T
, Sorrell
JT
, Stoddard
JA
, Petkus
AJ
, et al. A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain
. Pain
. 2011
Sep
;152
(9
):2098
–107
.
[PubMed]
0304-3959© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
