Mélanie Bérubé1,2, Géraldine Martorella3,4, Caroline Côté1, Céline Gélinas5,6, Nancy Feeley5,6, Manon Choinière7,8, Stefan Parent9,10, David L Streiner11,12. 1. Faculty of Nursing, Laval University. 2. Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Research Center of the Quebec University Health Center (Enfant-Jesus Hospital), Quebec City. 3. College of Nursing, Florida State University. 4. Tallahassee Memorial Hospital Center for Research and Evidence-Based Practice, Tallahassee, FL. 5. Ingram School of Nursing, McGill University. 6. Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. 7. Research Center of the Montreal University Health Center. 8. Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Montreal University. 9. Orthopaedic Department, Montreal University Health Center (Ste-Justine Hospital). 10. Surgery Department, University of Montreal, Montreal, QC. 11. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton. 12. Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Abstract
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.
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 painpatients 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.