Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, et al. Which Interventions Enhance Pain Self-efficacy in People With Chronic Musculoskeletal Pain? A Systematic Review With Meta-analysis of Randomized Controlled Trials, Including Over 12 000 Participants. J Orthop Sports Phys Ther. 2020 Aug;50(8):418-430. doi: 10.2519/jospt.2020.9319. (Systematic review)

OBJECTIVE: To find out which interventions enhance pain self-efficacy in people with chronic musculoskeletal pain and to evaluate the reporting of interventions designed to enhance pain self-efficacy.

DESIGN: Intervention systematic review with meta-analysis.

LITERATURE SEARCH: PubMed, Embase, Scopus, PsycINFO, CINAHL, PEDro, and the Cochrane Central Register of Controlled Trials were searched from inception up to September 2019.

STUDY SELECTION CRITERIA: Randomized controlled trials evaluating pain self-efficacy as a primary or secondary outcome in chronic musculoskeletal pain.

DATA SYNTHESIS: We used the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the risk of bias and the certainty of the evidence, respectively.

RESULTS: Sixty randomized controlled trials were included (12 415 participants). There was a small effect of multicomponent, psychological, and exercise interventions improving pain self-efficacy at follow-ups of 0 to 3 months, a small effect of exercise and multicomponent interventions enhancing pain self-efficacy at follow-ups of 4 to 6 months, and a small effect of multicomponent interventions improving pain self-efficacy at follow-ups of 7 to 12 months. No interventions improved pain self-efficacy after 12 months. Self-management interventions did not improve pain self-efficacy at any follow-up time. Risk of bias, the nature of the control group, and the instrument to assess pain self-efficacy moderated the effects of psychological therapies at follow-ups of 7 to 12 months. The certainty of the evidence for all included interventions was low, due to serious risk of bias and indirectness. No trial reported the intervention in sufficient detail to allow full replication.

CONCLUSION: There was low-quality evidence of a small effect of multicomponent exercise and psychological interventions improving pain self-efficacy in people with chronic musculoskeletal pain. J Orthop Sports Phys Ther 2020;50(8):418-430. doi:10.2519/jospt.2020.9319.

Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
Comments from MORE raters

Physician rater

This is a good article and useful read.

Physician rater

This paper represents an enormous amount of hard work and it is disappointing that the results are so inconclusive. Although this is to a measurable extent due to poor design of many of the studies examined, there appears to be sufficient evidence to show that the results of this investigation are robust in a clinical context. Nevertheless as a clinician, I would not rule out prescribing cognitive-behaviour therapy and/or exercise for patients with chronic musculo-skeletal pain. This paper does not examine the value of the treatment interventions described if the therapies are reinforced at regular intervals during the treatment process.

Physician rater

This review is a valuable synthesis of a literature that is published in diverse journals.

Rehab Clinician (OT/PT) rater

Excellent subject and very useful study.

Rehab Clinician (OT/PT) rater

This systematic review is of particular interest to occupational therapists working in physical or mental health. Therapeutic relationship and self efficacy are important components of coping with pain. Of particular interest is the lack of evidence for self management.
Comments from PAIN+ CPN subscribers

Ms. Carolynn Bulmer (8/27/2020 2:07 PM)

I work with individuals in a regular support group who have chronic pain/illness. We look at our mission as self-management and help. One thing does not bring relief to everyone. The variety of help is as varied as the individuals themselves. We advocate for self-discovery of what does or does not work, and to develop the strategy to your own benefit. We provide good solid information on topics requested by individuals to assist them in making the best decisions for themselves. We encourage good doctor/patient honest relationships, and we support individuals who have physical and mental issues when needed.