Table 2 Grading of the evidence for the meta-analyses of RCTs investigating the effectiveness of various 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 |