Authors' objectives: This HTA informs the following decision problems: • With a view to increasing access to CBT-based therapy, the purpose of this HTA is to inform decisions as to whether iCBT should be offered as a treatment option, as part of a multidisciplinary approach, in the delivery of care for chronic non-cancer pain when CBT would otherwise be provided. • Additionally, if evidence demonstrates that iCBT should be offered, the HTA could also inform whether there are criteria to guide decision-making regarding the suitability of iCBT for various pain conditions and people experiencing chronic pain, or other factors that should guide its implementation.

Authors' results and conclusions: • 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, and consider privacy and technological concerns or challenges.

Project Status: Completed

URL for project: https://www.cadth.ca/internet-delivered-cognitive-behavioural-therapy-treatment-chronic-non-cancer-pain

URL for protocol: https://www.cadth.ca/sites/default/files/hta-he/HT0037-OP0550_iCBT%20for%20Chronic%20Pain-protocol-Final.pdf

Year Published: 2022

URL for published report: https://www.cadth.ca/sites/default/files/hta-he/HT0037-iCBT-for-Chronic-Pain.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: <p>Canadian Agency for Drugs and Technologies in Health (CADTH)</p>