Internet-Based Pain Self-Management for Veterans: Feasibility and Preliminary Efficacy of the Pain EASE Program

Diana M. Higgins, Eugenia Buta, David A. Williams, Allison Halat, Matthew J. Bair, Alicia A. Heapy, Sarah L. Krein, Haseena Rajeevan, Marc I. Rosen, Robert D. Kerns

Research output: Contribution to journalArticle


Objective: To develop and test the feasibility and preliminary efficacy of a cognitive behavioral therapy–based, internet-delivered self-management program for chronic low back pain (cLBP) in veterans. Methods: Phase I included program development, involving expert panel and participant feedback. Phase II was a single-arm feasibility and preliminary efficacy study of the Pain e-health for Activity, Skills, and Education (Pain EASE) program. Feasibility (ie, website use, treatment credibility, satisfaction) was measured using descriptive methods. Mixed models were used to assess mean within-subject changes from baseline to 10 weeks post-baseline in pain interference (primary outcome, West Haven-Yale Multidimensional Pain Inventory, scale of 0 to 6), pain intensity, mood, fatigue, sleep, and depression. Results: Phase I participants (n = 15) suggested modifications including style changes, content reduction, additional “Test Your Knowledge” quizzes, and cognitive behavioral therapy skill practice monitoring form revisions for enhanced usability. In Phase II, participants (n = 58) were mostly male (93%) and White (60%), and had an average age of 55 years (standard deviation [SD] = 12) and moderate pain (mean score 5.9/10); 41 (71%) completed the post-baseline assessment. Participants (N = 58) logged on 6.1 (SD = 8.6) times over 10 weeks, and 85% reported being very or moderately satisfied with Pain EASE. Pain interference improved from a mean of 3.8 at baseline to 3.3 at 10 weeks (difference 0.5 [95% confidence interval 0.1 to 0.9], P = 0.008). Within-subject improvement also occurred for some secondary outcomes, including mood and depression symptoms. Discussion: Veterans with cLBP may benefit from technology-delivered interventions, which may also reduce pain interference. Overall, veterans found that Pain EASE, an internet-based self-management program, is feasible and satisfactory for cLBP.

Original languageEnglish (US)
Pages (from-to)357-370
Number of pages14
JournalPain Practice
Issue number4
StatePublished - Apr 1 2020



  • chronic low back pain
  • clinical trial
  • cognitive behavioral therapy
  • internet
  • self-management

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Higgins, D. M., Buta, E., Williams, D. A., Halat, A., Bair, M. J., Heapy, A. A., Krein, S. L., Rajeevan, H., Rosen, M. I., & Kerns, R. D. (2020). Internet-Based Pain Self-Management for Veterans: Feasibility and Preliminary Efficacy of the Pain EASE Program. Pain Practice, 20(4), 357-370.