BACKGROUND: Psychological comorbidities in chronic pain (CP) are common and contribute to adverse health outcomes and poor quality of life. Evidence-based guidance for the management of depressive symptoms in CP is limited, particularly for mind-body interventions.
OBJECTIVES: To investigate the effectiveness of mind-body interventions for the management of depressive symptoms in people with CP.
STUDY DESIGN: Systematic review (SR) of SRs.
SETTING: SRs with meta-analyses of clinical interventions for the management of depressive symptoms in people with CP.
METHODS: This SR was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches were performed for MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports from inception to March 14, 2019. Reference lists and overviews were also hand-searched. SRs of mind-body interventions for CP were included if they conducted a meta-analysis of depression outcomes in people with any CP type not including headache. Two independent reviewers screened, extracted, and evaluated the quality of articles found. Quality was assessed using the AMSTAR 2 criteria and data were summarized narratively with standardized mean differences and 95% confidence intervals of the depression outcome.
RESULTS: Eleven SRs with 20 distinct meta-analyses demonstrated a small to moderate beneficial effect for mind-body interventions (effect sizes: -0.05 to -0.63).
LIMITATIONS: Depressive symptomatology was a subordinate concern compared with other outcomes. The primary literature base was reasonably broad with 33 primary studies, but small when compared with the number of meta-analyses.
CONCLUSIONS: Mind-body interventions show consistent small to moderate effects in reducing depressive symptoms in CP. The literature in this area demonstrates understudy and oversynthesis. There is a need for more clinical trials focusing on people with axial pain, people with comorbid major depressive disorder, and with depression as the primary outcome of interest. Full SR registered on PROSPERO: CRD42019131871.
The limitations chapter is the strength of this paper.
This is an interesting study that confirms some information that, as a Psychiatrist, I already suspected could be beneficial. With this review, I may "prescribe" this type of treatment knowing that there is some literature supporting it.
This paper is a systematic review of relevant systematic reviews in this field. As many of the papers reviewed are concerned with the chronic painful complaint of fibromyalgia, the results are weighted towards the outcome of treatment in this population. As in many reviews in this area, the results show that there is a slight reduction in depressive symptoms when mind-body interventions are employed in treatment in this population. However, as the studies involved were of short duration, it is not known how long this effect lasts. Patients with chronic pain are very heterogenous and so studies of this sort suffer because they are not confined to a specific bodily condition.
While not the subject of this paper, it highlights that the treatment outcomes in depression should have somatic symptoms and pain as one axis of outcome.
The value of the study, in my opinion, is that looks at the efficacy of alternative methods (mind/body) to treat CP, other than pharmacological alternatives. The main limitation, is that analyzes a population with "symptoms" of depression and not those with a full diagnosis of MDD, that often correlates with CP as we can see in our practices. Therefore, I do not consider its findings that important, except to suggest further studies. It lacks the inclusion of males that in this case, have a higher incidence of CP resulting from accidents at work, and being overrepresented in sectors such as industrial and construction in Canada.
This is useful information for clinical work. It would be interesting to know the correlation of depression symptoms with chronic pain ratings and whether the interventions improved both outcomes.