Discussion
lower pain, fibromyalgia, vulvodynia, pain, chronic pain
CHRONIC PAIN, FIBROMYALGIA, VULVODYNIA
This study evaluated an internet-based treatment for provoked vulvodynia from a health economic perspective. After the internet-based treatment, the intervention group reported fewer visits to a midwife than the control group, but no statistically significant differences between groups regarding the total number of visits to different healthcare professions, treatment length, health-related quality of life, QALYs, or costs for treatment.In the present study, the groups differed at baseline regarding previous contact with a physiotherapist, where the intervention reported more often contact with a physiotherapist than the control group. Patients with provoked vulvodynia are a heterogenous group and care seeking behavior may vary in this populationMost of participants in the sample received clinical treatment after the intervention period, which is in line with results of a previous study, where participants of the internet-based treatment for vulvodynia described a need for continued contact with healthcare to work on remaining symptomsPrevious studies investigating internet interventions based on CBT for chronic pain demonstrated a reduction in symptoms and medical care use and that this form of treatment can be cost-effective when compared with face-to-face CBTThe intervention group had fewer visits to a midwife than the control group, suggesting that the internet-based treatment may reduce the need for contact with healthcare, which corroborates the results of another study investigating an internet intervention based on CBT for fibromyalgia in SwedenThere was no difference between groups regarding health-related quality of life, but as the sample was small and EQ-5D-3L is not sensitive to change, this was expectedDue to the few numbers of participants rating pain during intercourse in the randomized study, the calculation the incremental cost-effectiveness ratio was analyzed using pain acceptance as clinical measure to determine a meaningful clinical change. However, pain acceptance is an important clinical measure as it has been associated with lower pain severity and greater sexual functioning in women with vulvodyniaThe cost-effectiveness analysis considered differences in costs in relation to clinical effects and indicated that treatment did not aggravate symptoms, but rather could improve them. Despite the lack of statistical significance between groups regarding costs for treatment, the estimated costs to achieve clinical meaningful improvements in pain acceptance was low. This result suggested that the internet-based treatment may be a valuable complement to clinical treatment, which is in agreement with the results of another study investigating internet-delivered ACT for chronic pain