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Table 2 Grading of the evidence for the meta-analyses of RCTs investigating the effectiveness of various psychological interventions for pain reduction

From: An umbrella review of the literature on the effectiveness of psychological interventions for pain reduction

Author, Year Intervention Group Control group Type of pain Total N Largest Studya, b Summary random effects (95% CI)a, c Random P-value d 95% Prediction interval Egger’s
P-valuea
I2 (%) Studies Excess significancee
O/Eg P-valueh
Associations supported by strong evidence
None of the associations studied was supported by strong evidence
Associations supported by highly suggestive evidence
None of the associations studied was supported by highly suggestive evidence
Associations supported by suggestive evidence
Bernardy K, 2013 CBT AC/AtC/EDU/TAU/Support Fibromyalgia, end of treatment 1150 −0.62 (−0.89, −0.34) −0.30 (−0.45, −0.15) 7.4E-05 −0.69, 0.09 0.37 30 18 4/17.17 NP
Birnie K, 2014 Distraction NR Needle-related (children, adolescents), self-reported 2472 0.09 (−0.08, 0.27) −0.44 (−0.67, −0.21) 2.0E-04 −1.53, 0.65 0.13 86 24 7/3.4 0.07
Dixon K, 2007 CBT/Stress management/HYP NR Arthritis 2303 −0.15 (−0.28, −0.02) −0.20 (−0.30, −0.10) 8.5E-05 −0.37, −0.02 0.02 9 20 5/5.03 NP
Du S, 2011 ASMP/Self-management WL/ UC/ Conventional/No treatment Chronic musculoskeletal, 6 m 1018 −0.27 (−0.42, −0.12) −0.29 (−0.42, −0.16) 6.0E-06 −1.11, 0.53 0.25 0 3 3/2.78 1.00
Du S, 2011 ASMP/Self-management WL/ UC/ Conventional/No treatment Chronic musculoskeletal, 4 m 2968 −0.35 (−0.49, −0.20) −0.23 (−0.36, −0.11) 2.9E-04 −0.59, 0.13 0.73 59 8 4/7.94 NP
Eccleston C, 2014 Psychological therapies (Internet-delivered) AC/TAU/WL Chronic (Non-HA), post-treatment 1785 −0.20 (−0.36, −0.05) −0.37 (−0.59, −0.15) 9.9E-04 −1.12, 0.38 0.42 77 11 5/5.96 NP
Henrich J, 2015 Psychological therapies Control Irritable bowel syndrome 2245 0.05 (−0.19, 0.28) 0.40 (0.30, 0.51) 3.3E-14 0.09, 0.72 0.01 26 32 9/2.22 <0.001
Johannsen M, 2013 EDU/RIMH/SGT WL/ St. Care/ NR Breast cancer patients/survivors 1500 0.09 (−0.14, 0.31) 0.34 (0.18, 0.50) 3.3E-05 −0.15, 0.82 0.06 50 15 6/2.24 0.02
Knittle K, 2010 Self-regulation WL/St. Care/No Intervention Rheumatoid Arthritis 1316 0.13 (−0.16, 0.41) 0.18 (0.07, 0.29) 8.9E-04 0.07, 0.30 0.53 0 22 1/3.73 NP
Kroon FP, 2014 SMP UC/WL/No treatment Osteoarthritis, IT 2271 −0.29 (−0.51, −0.07) −0.17 (−0.26, −0.08) 1.6E-04 −0.27, −0.07 0.12 0 13 2/10.85 NP
Macea DD, 2010 Web-based CBT interventions Control Chronic pain 2958 0.28 (0.13, 0.42) 0.29 (0.15, 0.43) 6.3E-05 −0.07, 0.64 0.11 45 11 3/6.99 NP
Sheinfeld Gorin S, 2012 Psychological intervention Control Cancer Pain severity 4270 0.14 (−0.08, 0.36) 0.34 (0.23, 0.46) 7.2E-09 −0.21, 0.89 0.67 60 38 17/9.63 0.01
Associations supported by weak evidence
Adachi T, 2013 Hypnosis St. Care Chronic, post-intervention 46 0.64 (−0.27, 1.55) 1.10 (0.17, 2.02) 0.020 NA NA 48 2 1/1.52 NP
Aqqarwal VR, 2011 Any psychosocial intervention Usual treatment Muscle palpation, >3 m 143 −1.11 (−1.63, −0.59) i −1.09 (−1.56, −0.61)i 7.0E-06 −4.15, 1.98 0.61 0 3 1/2.05 NP
Aqqarwal VR, 2011 CBT Usual treatment Orofacial, >3 m 383 −0.32 (−0.66, 0.01) −0.25 (−0.46, −0.05) 0.014 −0.70, 0.19 0.91 0 4 1/3.11 NP
Aqqarwal VR, 2011 CBT + BFB Usual treatment Orofacial, >3 m 196 −0.82 (−1.23, −0.41) −0.46 (−0.92, 0.00) 0.049 −5.22, 4.30 0.47 53 3 1/3 NP
Aqqarwal VR, 2011 Hypnosis REL Orofacial, ≤3 m 81 −1.90 (−3.37, −0.43) i −1.84 (−3.26, −0.42)i 0.011 NA NA 0 2 1/1.26 NP
Bernardy K, 2013 CBT AC/AtC/EDU/TAU/Support Fibromyalgia (self-efficacy), end of treatment 589 −0.93 (−1.32, −0.54) −0.39 (−0.73, −0.06) 0.022 −1.50, 0.71 0.88 74 9 5/8.99 NP
Bernardy K, 2013 CBT AC/AtC/EDU/TAU/Support Fibromyalgia (self-efficacy), LT 494 −1.01 (−1.40, −0.61) −0.52 (−1.04, 0.00) 0.049 −2.32, 1.28 0.82 86 8 3/8 NP
Bernardy K, 2013 Operant therapy AC/EDU/TAU Fibromyalgia (self-efficacy), LT 123 −1.16 (−1.73, −0.59) −1.69 (−2.76, −0.62) 0.002 NA NA 83 2 2/2 1.00
Bernardy K, 2013 CBT AC/AtC/EDU/TAU/Support Fibromyalgia, LT 770 −0.37 (−0.74, 0.00) −0.28 (−0.43, −0.14) 1.3E-04 −0.47, −0.10 0.64 2 13 3/9.36 NP
Bernardy K, 2013 Operant therapy AC/EDU/TAU Fibromyalgia, LT 123 −0.76 (−1.31, −0.21) −1.27 (−2.30, −0.24) 0.015 NA NA 83 2 2/2 1.00
Damen L, 2006 REL + CBT Attention placebo HA Post-treatment 69 0.33 (−0.14, 0.79) 0.39 (0.01, 0.77) 0.045 NA NA 0 2 0/1.21 NP
Du S, 2011 ASMP/Self-management WL/ UC/ Conventional/No treatment Chronic musculoskeletal, 12 m 1570 −0.05 (−0.19, 0.08) −0.13 (−0.24, −0.03) 0.008 −0.30, 0.03 0.17 0 5 1/0.71 0.53
Eccleston C, 2014 Psychological therapies Control Chronic and recurrent HA (children, adolescents), follow-up 251 0.12 (0.02, 0.23) 0.49 (0.08, 0.90) 0.019 −0.76, 1.75 0.00 60 5 2/1.4 0.62
Eccleston C, 2014 Psychological therapies Control Chronic and recurrent HA (children, adolescents), post-treatment 714 0.32 (0.13, 0.52) 0.44 (0.28, 0.60) 1.2E-07 0.08, 0.80 0.00 25 15 7/7.46 NP
Eccleston C, 2014 Psychological therapies Control Chronic and recurrent non-HA (children, adolescents), post-treatment 852 0.21 (−0.10, 0.51) −0.57 (−0.86, −0.27) 2.0E-04 −1.63, 0.50 0.00 75 13 5/4.58 0.78
Eccleston C, 2014 Psychological therapies (Internet-delivered) AC/TAU/WL Chronic HA, post-treatment 131 0.99 (0.35, 1.64) 1.10 (0.54, 1.65) 1.0E-04 NA NA 0 2 2/1.94 1.00
Fisher E, 2014 CBT/BFB/REL/HYP WL/EDU/St. Care/Self-monitoring Chronic (excluding HA) 672 0.21 (−0.10, 0.51) −0.60 (−0.91, −0.29) 1.7E-04 −1.63, 0.44 0.00 71 11 4/3.65 0.76
Fisher E, 2014 CBT/BFB/REL/HYP WL/EDU/St. Care/Self-monitoring Headache 748 0.25 (−0.03, 0.54) 0.50 (0.34, 0.66) 3.9E-10 0.18, 0.83 0.00 16 18 7/6.65 1.00
Guzman J, 2002 Intensive (>100 h) daily MBPSR with functional restoration NR Low back, 3-4 m 165 −0.45 (−0.86, −0.04) −0.57 (−0.88, −0.26) 3.5E-04 NA NA 0 2 2/1.94 1.00
Henschke N, 2011 CBT WL Chronic low back, ST 239 −0.54 (−0.93, −0.15) −0.60 (−0.97, −0.23) 0.002 −1.66, 0.46 0.34 43 5 2/4.12 NP
Henschke N, 2011 Operant therapy WL Chronic low back, ST 153 −0.63 (−1.12, −0.13) −0.43 (−0.75, −0.11) 0.009 −2.52, 1.66 0.32 0 3 1/2.95 NP
Henschke N, 2011 Respondent therapy (EMG BFB) WL Chronic low back, ST 64 −1.19 (−2.01, −0.37) −0.80 (−1.32, −0.28) 0.002 −4.17, 2.56 0.76 0 3 1/2.99 NP
Henschke N, 2011 Respondent therapy (progressive REL) WL Chronic low back, ST 74 −10.20 (−23.95, 3.55) i −19.77 (−34.34, −5.20)i 0.008 −175.53, 135.98 0.53 57 3 1/1.94 NP
Kamper SJ, 2014 MBR UC Chronic low back, IT 740 −0.24 (−0.50, 0.03) −0.60 (−0.85, −0.34) 5.1E-06 −1.37, 0.18 0.01 63 6 5/3.95 0.67
Kamper SJ, 2014 MBR Physical treatment Chronic low back, IT 531 −0.04 (−0.40, 0.32) −0.28 (−0.54, −0.01) 0.039 −1.01, 0.45 0.17 51 9 2/0.54 0.10
Kamper SJ, 2014 MBR UC Chronic low back, LT 821 −0.32 (−0.60, −0.04) −0.21 (−0.37, −0.04) 0.013 −0.57, 0.15 0.68 26 7 2/5.94 NP
Kamper SJ, 2014 MBR UC Chronic low back, ST 879 −0.20 (−0.46, 0.05) −0.55 (−0.83, −0.27) 1.0E-04 −1.44, 0.33 0.29 72 9 5/3.94 0.52
Kamper SJ, 2014 MBR WL Chronic low back, ST 213 −0.45 (−0.84, −0.06) −0.73 (−1.22, −0.24) 0.003 −6.10, 4.64 0.78 63 3 2/2.66 NP
Kamper SJ, 2014 MBR Physical treatment Chronic low back, ST 1661 −0.15 (−0.36, 0.05) −0.30 (−0.54, −0.06) 0.015 −1.15, 0.55 0.62 80 12 3/4.53 NP
Kisely SR, 2015 Psychological intervention No psychological intervention Chest (frequency), ≤3 m 294 −0.09 (−0.57, 0.39) i −2.26 (−4.41, −0.11)i 0.039 −8.95, 4.42 0.29 94 7 4/0.45 <0.001
Kisely SR, 2015 Psychological intervention No psychological intervention Chest, ≤3 m 172 −0.21 (−0.34, −0.06) −0.20 (−0.35, −0.05) 0.008 −1.78, 1.38 0.75 58 3 2/2.98 NP
Kisely SR, 2015 Psychological intervention No psychological intervention Chest, 3-12 m 111 −0.29 (−0.49, −0.09) −0.30 (−0.44, −0.15) 6.1E-05 NA NA 0 2 2/2 1.00
Kroon FP, 2014 SMP UC/WL/No treatment Osteoarthritis, ST 755 −0.32 (−0.61, −0.03) −0.26 (−0.41, −0.11) 8.2E-04 −0.47, −0.04 0.89 0 6 2/5.09 NP
Kroon FP, 2014 SMP Control Osteoarthritis, IT 574 −0.22 (−0.45, 0.01) −0.26 (−0.43, −0.09) 0.003 −1.38, 0.86 0.27 0 3 0/2.16 NP
Lakhan S, 2013 MBT/MBCT EDU/WL/Support Irritable bowel syndrome 160 −0.64 (−1.08, −0.20) −0.59 (−0.91, −0.27) 2.6E-04 NA NA 0 2 2/2 1.00
Mustafa M, 2013 Supportive/expressive group therapy Usual treatment Metastatic breast cancer 279 −0.75 (−1.36, −0.14) i −0.58 (−0.99, −0.17)i 0.005 −3.21, 2.05 0.90 0 3 1/2.94 NP
Peerdeman K, 2016 Imagery Control/No treatment Pain relief 301 0.20 (−0.17, 0.56) 0.24 (0.01, 0.46) 0.039 −0.26, 0.73 0.28 0 4 0/1.6 NP
Peerdeman K, 2016 Verbal suggestion Control/No treatment Pain relief 383 0.24 (0.06, 0.41) 0.31 (0.16, 0.46) 6.4E-05 −0.02, 0.64 0.08 0 4 2/2.3 NP
Peerdeman K, 2016 Verbal suggestion/Imagery Control/No treatment Affective pain 169 0.16 (−0.27, 0.60) 0.34 (0.07, 0.61) 0.013 −1.41, 2.09 0.70 0 3 1/0.78 1.00
Roldan-Barraza C, 2014 Psychosocial Intervention/Psychosocial Intervention + Usual Treatment Tailored Usual Treatment MTMD (self-reported), LT 403 0.80 (0.14, 1.46) 0.66 (0.23, 1.09) 0.003 −2.13, 3.45 0.54 0 3 2/2.94 NP
Theadom A, 2015 Psychological therapies UC Fibromyalgia, 6 m 371 −0.38 (−0.75, −0.02) −0.52 (−0.76, −0.29) 1.5E-05 −1.06, 0.02 0.15 20 5 2/4.12 NP
Theadom A, 2015 Psychological therapies UC Fibromyalgia, post-intervention 453 −0.23 (−0.60, 0.15) −0.33 (−0.52, −0.15) 4.8E-04 −0.56, −0.11 0.90 0 9 2/3.1 NP
Uman LS, 2013 Hypnosis Control Needle-related (children, adolescents), self-reported 176 0.09 (−0.57, 0.74) −1.4 (−2.32, −0.47) 0.003 −4.81, 2.01 0.41 85 5 4/0.37 <0.001
Williams AC, 2012 Cognitive behavioural TAU Chronic (excl. HA), post-treatment 1148 −0.53 (−0.87, −0.19) −0.21 (−0.37, −0.05) 0.010 −0.72, 0.29 0.02 45 16 4/15.61 NP
  1. Abbreviations: AC Active control, AtC Attention control, ASMP Arthritis Self-Management Program, BFB Biofeedback, CBT Cognitive behavioural therapy, EDU Education, EMG BFB Electromyographic biofeedback, HA Headache, HYP Hypnotherapy, IM Imagination, IT Intermediate term, LT Long term, m Months, MBT Mindfulness-based therapy, MBCT Mindfulness-based cognitive therapy, MBPSR Multidisciplinary bio-psychosocial rehabilitation programs, MTMD Myofascial Temporomandibular Disorder, MBR Multidisciplinary biopsychological rehabilitation, NA Not applicable, because only two studies were available, NP Not pertinent, because the expected number of statistically significant studies is larger than the observed, NR Not reported, REL Relaxation, RIMH Relaxation, guided imagery, meditation or hypnosis, SGT Supportive group therapy, SMP Self-management education programmes, ST Short term, St. Care Standard care, TAU Treated as usual, UC Usual Care, WL Waiting list
  2. aAll summary point estimates on this table were indicative of pain reduction comparing the intervention to the control group. However, the original meta-analyses reported both positive and negative effects as observed on this table because they used different outcome metrics (e.g., pain reduction or difference in pain levels)
  3. bOn these comparisons MD is reported, instead of SMD
  4. cSummary effect and 95% confidence interval of largest study (smallest standard error) in each meta-analysis
  5. dRandom effects refer to summary effect (95% CI) using the random-effects model
  6. e P value of summary random effects estimate
  7. f P-value from the Egger’s regression asymmetry test
  8. gExpected number of statistically significant studies using the point estimate of the largest study (smallest standard error) as the plausible effect size
  9. hObserved/Expected number of statistically significant studies
  10. i P value of the excess statistical significance test. All statistical tests were two-sided