OBJECTIVE: Up to 50% of patients develop high-impact chronic pain after an acute care experience and many psychological variables have been identified in this process. We conducted a systematic review and meta-analysis of randomized controlled trials to assess the effect of psychological interventions within 3 months after pain onset.
METHODS: We searched databases for articles published from databases inceptions until July 2019. We used standardized mean differences with 95% confidence intervals to assess treatment effect.
RESULTS: In all, 18 trials were found eligible; 11 of which were included in the meta-analyses. Trials were mainly performed in back pain patients in the middle to late adulthood. Regarding pain intensity, the effect of psychological interventions compared with standard treatments was nonsignificant at 3, 6, and 12 months. We found a moderate significant effect size in favor of psychological interventions compared with standard treatments with regard to disability at 12 months and a small significant effect with regard to coping with pain at 3 months when compared with information alone. Most of meta-analysis findings were associated with a low level of evidence.
DISCUSSION: This systematic review and meta-analysis showed no significant effect of psychological interventions on pain intensity. A positive and significant trend related to these interventions was shown on disability and coping with pain, when compared with standard treatment and information, respectively. However, these findings must be interpreted with caution considering the limited sample of trials. More rigorous randomized controlled trials performed in patients with a high-risk psychological profile are required to elucidate the efficacy of psychological interventions in preventing chronic pain.
Despite the potential interest in this paper, it does not show a clear benefit from a psychologic intervention. It is, therefore, not as useful as I expected it to be.
RCTs about intervention on pain mostly have patient-reported outcome measures (PROMs) as a primary outcome. The COSMIN group has published a checklist for systematic reviews using PROMs as (primary) outcome, to assess the content validity and the construct validity of the used PROMs. No such assessment was done in the present systematic review. Therefore, we do not of the validity of the used measure in the included RCTs. Thus, we do not know how valid the results are of the RCTs and, thereby, also the present systematic review.
This article aims to examine whether psychological interventions alter the course of symptoms and disability following the onset of acute pain. Relatively few studies were available for this systemic analysis and although the majority of patients had back pain, there was not homogeneity in the diagnoses. The results were as I would expect with no change in the intensity of pain on follow-up. There were some improvements on measures of disability in the treatment group at the end of the trial, but it is difficult to assess how significant these are as many measures of disability were used in the analysis. The Oswestry Disability Index and the Beck Depression Inventory were both used as measures of disability, but these two instruments measure very different aspects of impaired function. Studies of this type would be more meaningful if a more homogenous population was studied using a standard intervention.
These findings are very relevant to the usefulness of psychological treatment to reduce disability and improve quality of life for patients with back pain.
Useful information but limited by weaknesses in methodology. More research needed in this area.