PEARLS 197, September 2009, written by Brian R McAvoy

Clinical question

How effective are psychological therapies for management of chronic pain (excluding headache) in adults?

Bottom line

Cognitive behavioural therapy (CBT) and behavioural therapy (BT)have weak effects in improving pain. CBT and BT have minimal effects on disability associated with chronic pain. CBT and BT are effective in altering mood outcomes (depression and anxiety), and there is some evidence these changes are maintained at 6 months. The changes typically come to 0.5 or less on a 10-point scale. Guidance is still required on the best content, duration, intensity and format of treatment.

Caveat

An analysis of the quality rating scores showed the quality of the design and reporting of trials has clearly improved over the years. However, the quality of treatments, or of their reporting,or both, does not appear to have improved over time.

Context

Chronic pain is a common problem, causing significant distress and disability. Behavioural and cognitive treatments designed to ameliorate pain, distress and disability were first introduced over 40 years ago and are now well established. 1,2

Cochrane Systematic Review

Eccleston C et al. Psychological therapies for the management of chronic pain (excluding headache) in adults. This review contains 40 studies involving 4781 participants.

Further references

1. Fordyce WE et al. J Chronic Dis 1968;21:179-90.
2. Keefe FJ et al. J Pain 2004;5:195-211.