Psychological interventions for patients with chronic pain. Individual compared to group treatment

Chronic pain is common and can lead to great suffering for those affected. Pain conditions are also the reason for a lot of the sick leave in Sweden. Psychological interventions such as CBT and ACT are commonly used methods to treat chronic pain.

Question

What scientific studies are there on the effect of psychological interventions with CBT or ACT, delivered either as individual or in group, to persons with chronic pain?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
G-CBT = Group-based cognitive behavioral therapy; I-CBT = Individual cognitive behavioral therapy; SMD = Standardized mean difference
Included studies Population/Intervention Outcome
Niknejad et al, 2018, [1]
Study designs: Included only randomized controlled trials

n=22 studies with a total of 2608 participants.

Risk of bias: Used Yates quality scores, where a score of 22.7 is deemed as excellent quality. The mean quality scores in the included studies were 24.5.
Population: Elderly (Mean age >60 years) with chronic (>3 mon) non-cancerous pain.

Intervention:
Evaluation of a CBT technique. For example, behavioural and cognitive coping skills, cognitive restructuring, behavioural activation, and acceptance.

Control:
Different in the different studies including waiting list, exercise, education, usual care
Pain intensity at short follow-up (SMD):
G-CBT compared to control:
–0.202 (p=0.08)
I-CBT compared to control:
–0.120 (p=0.38)
Because of lack of documented results, no more outcomes connected to individual vs group treatment could be presented.
Authors' conclusion:
“The observed benefits were strongest when delivered using group-based approaches. Potential mechanisms that could account for this finding include access to peer support, social facilitation of target behaviours, and public commitment to therapy goals.”

References

  1. Niknejad B, Bolier R, Henderson CR, Delgado D, Kozlov E, Löckenhoff CE, et al. Association between psychological interventions and chronic pain outcomes in older adults: A systematic review and meta-analysis. JAMA Intern Med 2018;178:830-839.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 7/6/2021
Report no: ut202118
Registration no: SBU 2021/173