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Meta-Analysis
. 2020 Aug 12;8(8):CD007407.
doi: 10.1002/14651858.CD007407.pub4.

Psychological therapies for the management of chronic pain (excluding headache) in adults

Amanda C de C Williams  1 , Emma Fisher  2   3 , Leslie Hearn  2 , Christopher Eccleston  3
Affiliations
Meta-Analysis

Psychological therapies for the management of chronic pain (excluding headache) in adults

Amanda C de C Williams et al. Cochrane Database Syst Rev. .

Abstract

Background: Chronic non-cancer pain, a disabling and distressing condition, is common in adults. It is a global public health problem and economic burden on health and social care systems and on people with chronic pain. Psychological treatments aim to reduce pain, disability and distress. This review updates and extends its previous version, published in 2012.

Objectives: To determine the clinical efficacy and safety of psychological interventions for chronic pain in adults (age > 18 years) compared with active controls, or waiting list/treatment as usual (TAU).

Search methods: We identified randomised controlled trials (RCTs) of psychological therapies by searching CENTRAL, MEDLINE, Embase and PsycINFO to 16 April 2020. We also examined reference lists and trial registries, and searched for studies citing retrieved trials.

Selection criteria: RCTs of psychological treatments compared with active control or TAU of face-to-face therapies for adults with chronic pain. We excluded studies of headache or malignant disease, and those with fewer than 20 participants in any arm at treatment end.

Data collection and analysis: Two or more authors rated risk of bias, extracted data, and judged quality of evidence (GRADE). We compared cognitive behavioural therapy (CBT), behavioural therapy (BT), and acceptance and commitment therapy (ACT) with active control or TAU at treatment end, and at six month to 12 month follow-up. We did not analyse the few trials of other psychological treatments. We assessed treatment effectiveness for pain intensity, disability, and distress. We extracted data on adverse events (AEs) associated with treatment.

Main results: We added 41 studies (6255 participants) to 34 of the previous review's 42 studies, and now have 75 studies in total (9401 participants at treatment end). Most participants had fibromyalgia, chronic low back pain, rheumatoid arthritis, or mixed chronic pain. Most risk of bias domains were at high or unclear risk of bias, with selective reporting and treatment expectations mostly at unclear risk of bias. AEs were inadequately recorded and/or reported across studies. CBT The largest evidence base was for CBT (59 studies). CBT versus active control showed very small benefit at treatment end for pain (standardised mean difference (SMD) -0.09, 95% confidence interval (CI) -0.17 to -0.01; 3235 participants; 23 studies; moderate-quality evidence), disability (SMD -0.12, 95% CI -0.20 to -0.04; 2543 participants; 19 studies; moderate-quality evidence), and distress (SMD -0.09, 95% CI -0.18 to -0.00; 3297 participants; 24 studies; moderate-quality evidence). We found small benefits for CBT over TAU at treatment end for pain (SMD -0.22, 95% CI -0.33 to -0.10; 2572 participants; 29 studies; moderate-quality evidence), disability (SMD -0.32, 95% CI -0.45 to -0.19; 2524 participants; 28 studies; low-quality evidence), and distress (SMD -0.34, 95% CI -0.44 to -0.24; 2559 participants; 27 studies; moderate-quality evidence). Effects were largely maintained at follow-up for CBT versus TAU, but not for CBT versus active control. Evidence quality for CBT outcomes ranged from moderate to low. We rated evidence for AEs as very low quality for both comparisons. BT We analysed eight studies (647 participants). We found no evidence of difference between BT and active control at treatment end (pain SMD -0.67, 95% CI -2.54 to 1.20, very low-quality evidence; disability SMD -0.65, 95% CI -1.85 to 0.54, very low-quality evidence; or distress SMD -0.73, 95% CI -1.47 to 0.01, very low-quality evidence). At follow-up, effects were similar. We found no evidence of difference between BT and TAU (pain SMD -0.08, 95% CI -0.33 to 0.17, low-quality evidence; disability SMD -0.02, 95% CI -0.24 to 0.19, moderate-quality evidence; distress SMD 0.22, 95% CI -0.10 to 0.54, low-quality evidence) at treatment end. At follow-up, we found one to three studies with no evidence of difference between BT and TAU. We rated evidence for all BT versus active control outcomes as very low quality; for BT versus TAU. Evidence quality ranged from moderate to very low. We rated evidence for AEs as very low quality for BT versus active control. No studies of BT versus TAU reported AEs. ACT We analysed five studies (443 participants). There was no evidence of difference between ACT and active control for pain (SMD -0.54, 95% CI -1.20 to 0.11, very low-quality evidence), disability (SMD -1.51, 95% CI -3.05 to 0.03, very low-quality evidence) or distress (SMD -0.61, 95% CI -1.30 to 0.07, very low-quality evidence) at treatment end. At follow-up, there was no evidence of effect for pain or distress (both very low-quality evidence), but two studies showed a large benefit for reducing disability (SMD -2.56, 95% CI -4.22 to -0.89, very low-quality evidence). Two studies compared ACT to TAU at treatment end. Results should be interpreted with caution. We found large benefits of ACT for pain (SMD -0.83, 95% CI -1.57 to -0.09, very low-quality evidence), but none for disability (SMD -1.39, 95% CI -3.20 to 0.41, very low-quality evidence), or distress (SMD -1.16, 95% CI -2.51 to 0.20, very low-quality evidence). Lack of data precluded analysis at follow-up. We rated evidence quality for AEs to be very low. We encourage caution when interpreting very low-quality evidence because the estimates are uncertain and could be easily overturned.

Authors' conclusions: We found sufficient evidence across a large evidence base (59 studies, over 5000 participants) that CBT has small or very small beneficial effects for reducing pain, disability, and distress in chronic pain, but we found insufficient evidence to assess AEs. Quality of evidence for CBT was mostly moderate, except for disability, which we rated as low quality. Further trials may provide more precise estimates of treatment effects, but to inform improvements, research should explore sources of variation in treatment effects. Evidence from trials of BT and ACT was of moderate to very low quality, so we are very uncertain about benefits or lack of benefits of these treatments for adults with chronic pain; other treatments were not analysed. These conclusions are similar to our 2012 review, apart from the separate analysis of ACT.

PubMed Disclaimer

Conflict of interest statement

AW: none known; AW is an author of an included study but was not involved in the data extraction or ratings of bias and quality for that study.

EF: none known.

LH: none known.

CE: none known. Since CE is an author as well as the PaPaS Co‐ordinating Editor at the time of writing, we acknowledge the input of Andrew Moore who acted as Sign Off Editor for this review. CE had no input into the editorial decisions or processes for this review.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study.
3
3
'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1: Cognitive behavioural vs active control at the end of treatment, Outcome 1: Pain post‐treatment
1.2
1.2. Analysis
Comparison 1: Cognitive behavioural vs active control at the end of treatment, Outcome 2: Disability post‐treatment
1.3
1.3. Analysis
Comparison 1: Cognitive behavioural vs active control at the end of treatment, Outcome 3: Distress post‐treatment
1.4
1.4. Analysis
Comparison 1: Cognitive behavioural vs active control at the end of treatment, Outcome 4: Pain follow‐up
1.5
1.5. Analysis
Comparison 1: Cognitive behavioural vs active control at the end of treatment, Outcome 5: Disability follow‐up
1.6
1.6. Analysis
Comparison 1: Cognitive behavioural vs active control at the end of treatment, Outcome 6: Distress follow‐up
2.1
2.1. Analysis
Comparison 2: Cognitive behavioural vs treatment as usual, Outcome 1: Pain post‐treatment
2.2
2.2. Analysis
Comparison 2: Cognitive behavioural vs treatment as usual, Outcome 2: Disability post‐treatment
2.3
2.3. Analysis
Comparison 2: Cognitive behavioural vs treatment as usual, Outcome 3: Distress post‐treatment
2.4
2.4. Analysis
Comparison 2: Cognitive behavioural vs treatment as usual, Outcome 4: Pain follow‐up
2.5
2.5. Analysis
Comparison 2: Cognitive behavioural vs treatment as usual, Outcome 5: Disability follow‐up
2.6
2.6. Analysis
Comparison 2: Cognitive behavioural vs treatment as usual, Outcome 6: Distress follow‐up
3.1
3.1. Analysis
Comparison 3: Behavioural vs active control, Outcome 1: Pain post‐treatment
3.2
3.2. Analysis
Comparison 3: Behavioural vs active control, Outcome 2: Disability post‐treatment
3.3
3.3. Analysis
Comparison 3: Behavioural vs active control, Outcome 3: Distress post‐treatment
3.4
3.4. Analysis
Comparison 3: Behavioural vs active control, Outcome 4: Pain follow‐up
3.5
3.5. Analysis
Comparison 3: Behavioural vs active control, Outcome 5: Disability follow‐up
3.6
3.6. Analysis
Comparison 3: Behavioural vs active control, Outcome 6: Distress follow‐up
4.1
4.1. Analysis
Comparison 4: Behavioural vs treatment as usual, Outcome 1: Pain post‐treatment
4.2
4.2. Analysis
Comparison 4: Behavioural vs treatment as usual, Outcome 2: Disability post‐treatment
4.3
4.3. Analysis
Comparison 4: Behavioural vs treatment as usual, Outcome 3: Distress post‐treatment
4.4
4.4. Analysis
Comparison 4: Behavioural vs treatment as usual, Outcome 4: Pain follow‐up
4.5
4.5. Analysis
Comparison 4: Behavioural vs treatment as usual, Outcome 5: Disability follow‐up
4.6
4.6. Analysis
Comparison 4: Behavioural vs treatment as usual, Outcome 6: Distress follow‐up
5.1
5.1. Analysis
Comparison 5: Acceptance commitment therapy vs active control, Outcome 1: Pain post‐treatment
5.2
5.2. Analysis
Comparison 5: Acceptance commitment therapy vs active control, Outcome 2: Disability post‐treatment
5.3
5.3. Analysis
Comparison 5: Acceptance commitment therapy vs active control, Outcome 3: Distress post‐treatment
5.4
5.4. Analysis
Comparison 5: Acceptance commitment therapy vs active control, Outcome 4: Pain follow‐up
5.5
5.5. Analysis
Comparison 5: Acceptance commitment therapy vs active control, Outcome 5: Disability follow‐up
5.6
5.6. Analysis
Comparison 5: Acceptance commitment therapy vs active control, Outcome 6: Distress follow‐up
6.1
6.1. Analysis
Comparison 6: Acceptance commitment therapy vs treatment as usual, Outcome 1: Pain post‐treatment
6.2
6.2. Analysis
Comparison 6: Acceptance commitment therapy vs treatment as usual, Outcome 2: Disability post‐treatment
6.3
6.3. Analysis
Comparison 6: Acceptance commitment therapy vs treatment as usual, Outcome 3: Distress post‐treatment
6.4
6.4. Analysis
Comparison 6: Acceptance commitment therapy vs treatment as usual, Outcome 4: Pain follow‐up
6.5
6.5. Analysis
Comparison 6: Acceptance commitment therapy vs treatment as usual, Outcome 5: Disability follow‐up
6.6
6.6. Analysis
Comparison 6: Acceptance commitment therapy vs treatment as usual, Outcome 6: Distress follow‐up
7.1
7.1. Analysis
Comparison 7: Sensitivity analysis ‐ CBT vs active control, Outcome 1: Pain post‐treatment
7.2
7.2. Analysis
Comparison 7: Sensitivity analysis ‐ CBT vs active control, Outcome 2: Disability post‐treatment
7.3
7.3. Analysis
Comparison 7: Sensitivity analysis ‐ CBT vs active control, Outcome 3: Distress post‐treatment
7.4
7.4. Analysis
Comparison 7: Sensitivity analysis ‐ CBT vs active control, Outcome 4: Pain follow‐up
7.5
7.5. Analysis
Comparison 7: Sensitivity analysis ‐ CBT vs active control, Outcome 5: Disability follow‐up
7.6
7.6. Analysis
Comparison 7: Sensitivity analysis ‐ CBT vs active control, Outcome 6: Distress follow‐up
8.1
8.1. Analysis
Comparison 8: Sensitivity analysis ‐ CBT vs treatment as usual, Outcome 1: Pain post‐treatment
8.2
8.2. Analysis
Comparison 8: Sensitivity analysis ‐ CBT vs treatment as usual, Outcome 2: Disability post‐treatment
8.3
8.3. Analysis
Comparison 8: Sensitivity analysis ‐ CBT vs treatment as usual, Outcome 3: Distress post‐treatment
8.4
8.4. Analysis
Comparison 8: Sensitivity analysis ‐ CBT vs treatment as usual, Outcome 4: Pain follow‐up
8.5
8.5. Analysis
Comparison 8: Sensitivity analysis ‐ CBT vs treatment as usual, Outcome 5: Disability follow‐up
8.6
8.6. Analysis
Comparison 8: Sensitivity analysis ‐ CBT vs treatment as usual, Outcome 6: Distress follow‐up
See this image and copyright information in PMC

Update of

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McCracken 2013 {published data only}
    1. McCracken LM, Sato A, Taylor GJ. A trial of a brief group-based form of acceptance and commitment therapy (ACT) for chronic pain in general practice: pilot outcome and process results. Journal of Pain 2013;14(11):1398-406. - PMC - PubMed
Mishra 2000 {published data only}
    1. Mishra KD, Gatchel RJ, Gardea MA. The relative efficacy of three cognitive-behavioral treatment approaches to temporomandibular disorders. Journal of Behavioral Medicine 2000;23:293-309. - PubMed
Miziara 2009 {published data only}
    1. Miziara ID, Filhoa BCA, Oliveiraa R, Rodrigues dos Santos RM. Group psychotherapy: an additional approach to burningmouth syndrome. Journal of Psychosomatic Research 2009;67:443-8. - PubMed
Monticone 2013 {published data only}
    1. Monticone M, Ferrante S, Rocca B, Baiardi P, Dal Farra F, Foti C. Effect of a long-lasting multidisciplinary program on disability and fear-avoidance behaviors in patients with chronic low back pain: results of a randomized controlled trial. Clinical Journal of Pain 2013;29(11):929-38. - PubMed
Monticone 2016 {published data only}
    1. Monticone M, Ambrosini E, Rocca B, Cazzaniga D, Liquori V, Foti C. Group-based task-oriented exercises aimed at managing kinesiophobia improved disability in chronic low back pain. European Journal of Pain 2016;20:541-51. - PubMed
Monticone 2017 {published data only}
    1. Monticone M, Ambrosini E, Rocca B, Cazzaniga D, Liquori V, Pedrocchi A, et al. Group-based multimodal exercises integrated with cognitive-behavioural therapy improve disability, pain and quality of life of subjects with chronic neck pain: a randomized controlled trial with one-year follow-up. Clinical Rehabilitation 2017;31(6):742-52. - PubMed
Nicassio 1997 {published data only}
    1. Nicassio PM, Radojevic V, Weisman MH, Schuman C, Kim J, Schoenfeld-Smith K, et al. A comparison of behavioral and educational interventions for fibromyalgia. Journal of Rheumatology 1997;24:2000-7. - PubMed
Nicholas 2013 {published data only}
    1. Nicholas MK, Asghari A, Blyth FM, Wood BM, Murray R, McCabe R, et al. Self-management intervention for chronic pain in older adults: A randomised controlled trial. Pain 2013;154:824-35. - PubMed
Parker 1988 {published data only}
    1. Parker JC, Frank RG, Beck NC, Smarr KL, Buesher KL, Phillips LR, et al. Pain management in rheumatoid arthritis patients. A cognitive behavioural approach. Arthritis and Rheumatism 1988;31:593-601. - PubMed
Pincus 2015 {published data only}
    1. Pincus T, Anwar S, McCracken LM, McGregor A, Graham L, Collinson M, et al. Delivering an Optimised Behavioural Intervention (OBI) to people with low back pain with high psychological risk; results and lessons learnt from a feasibility randomised controlled trial of Contextual Cognitive Behavioural Therapy (CCBT) vs. physiotherapy. BMC Musculoskeletal Disorders 2015;16:147. - PMC - PubMed
Puder 1988 {published data only}
    1. Puder RS. Age analysis of cognitive-behavioral group therapy for chronic pain outpatients. Psychology and Aging 1988;3:204-7. - PubMed
Sattell 2012 {published data only}
    1. Sattell H, Lahmann C, Gündel H, Guthrie J, Kruse J, Noll-Hussong M, et al. Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: randomised controlled trial. British Journal of Psychiatry 2012;100:60-7. - PubMed
Scheidt 2013 {published data only}
    1. Scheidt CE, Waller E, Endorf K, Schmidt S, König R, Zeeck A, et al. Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial. General Hospital Psychiatry 2013;35:160-7. - PubMed
Sharpe 2012 {published data only}
    1. Sharpe L, Schrieber L. A blind randomized controlled trial of cognitive versus behavioral versus cognitive-behavioral therapy for patients with rheumatoid arthritis. Psychotherapy and Psychotherapeutics 2012;81(3):145-52. - PubMed
Sleptsova 2013 {published data only}
    1. Sleptsova M, Wössmer B, Grossman P, Langewitz W. Culturally sensitive group therapy for Turkish patients suffering from chronic pain: a randomised controlled intervention trial. Swiss Medical Weekly 2013;143:w13875. - PubMed
Smeets 2006 {published data only}
    1. Smeets R, Vlaeyen JWS, Hidding A, Kester ADM, Van Der Heijden G, Van Geel ACM, et al. Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial. BMC Musculoskeletal Disorders 2006;7:1-16. - PMC - PubMed
    1. Smeets R, Vlaeyen JWS, Kester ADM, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. Journal of Pain 2006;7:261-71. - PubMed
    1. Smeets RJEM, Vlaeyen JWS, Hidding A, Kester ADM, Heijden GJMG, Knottnerus JA. Chronic low back pain: physical training, graded activity with problem solving training, or both? The one-year post-treatment results of a randomized controlled trial. Pain 2008;134:263-76. - PubMed
Somers 2012 {published data only}
    1. Somers TJ, Blumenthal JA, Guilak F, Kraus VB, Schmitt DO, Babyak MA, et al. Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study. Pain 2012;153:1109-209. - PMC - PubMed
Strauss 1986 {published data only}
    1. Strauss GD, Spiegel JS, Daniels M, Speigel T, Landsverk J, Roy-Byne P, et al. Group therapies for rheumatoid arthritis. A controlled study of two approaches. Arthritis and Rheumatism 1986;29(10):1203-9. - PubMed
Tavafian 2011 {published data only}
    1. Tavafian SS, Jamshidi AR, Mohammad K. Treatment of chronic low back pain. A randomized clinical trial comparing multidisciplinary group-based rehabilitation program and oral drug treatment with oral drug treatment alone. Clinical Journal of Pain 2011;27:811–8. - PubMed
    1. Tavafian SS, Jamshidi AR, Mohammad K. Treatment of low back pain: Second extended follow up of an original trial (NCT00600197) comparing a multidisciplinary group-based rehabilitation program with oral drug treatment alone up to 30 months. International Journal of Rheumatic Diseases 2017;20:1910-6. - PubMed
    1. Tavafian SS, Jamshidi AR, Shay B. Treatment of low back pain: First extended follow up of an original trial (NCT00600197) comparing a multidisciplinary group-based rehabilitation program with oral drug treatment alone up to 24 months. International Journal of Rheumatic Diseases 2017;20:1902–9. - PubMed
Thieme 2003 {published data only}
    1. Thieme K, Gromnica-Ihle E, Flor H. Operant behavioral treatment of fibromyalgia: a controlled study. Arthritis and Rheumatism 2003;49:314-20. - PubMed
Thieme 2006 {published data only}
    1. Thieme K, Flor H, Turk DC. Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments. Arthritis Research & Therapy 2006;8:R121. - PMC - PubMed
    1. Thieme K, Turk DC, Gracely RH, Flor H. Differential psychophysiological effects of operant and cognitive behavioural treatments in women with fibromyalgia. European Journal of Pain 2016;20:1478-89. - PubMed
Thorn 2011 {published data only}
    1. Thorn BE, Day MA, Burns J, Kuhajda MC, Susan W Gaskins SW, Sweeney K, et al. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain 2011;152:2710-20. - PMC - PubMed
Thorn 2018 {published data only}
    1. Thorn BE, Eyer JC, Van Dyke BP, Torres CA, Burns JW, Kim M, et al. Literacy-adapted cognitive behavioral therapy versus education for chronic pain at low-income clinics. Annals of Internal Medicine 2018;168:471-80. - PubMed
Thorsell 2011 {published data only}
    1. Thorsell J, Finnes A, Dahl J, Lundgren T, Gybrant M, Gordh T, et al. A comparative study of two manual-based self-help interventions, acceptance and commitment therapy and applied relaxation, for persons with chronic pain. Clinical Journal of Pain 2011;27:716-23. - PubMed
Turner 1988 {published data only}
    1. Turner JA, Clancy S. Comparison of operant behavioral and cognitive-behavioral group treatment for chronic low back pain. Journal of Consulting & Clinical Psychology 1988;56:261-6. - PubMed
Turner 2006 {published data only}
    1. Turner JA, Mancl L, Aaron LA. Brief cognitive-behavioral therapy for temporomandibular disorder pain: effects on daily electronic outcome and process measures. Pain 2005;117:377-87. - PubMed
    1. Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial. Pain 2006;121:181-94. - PubMed
van Eijk 2013 {published data only}
    1. Eijk-Hustings Y, Kroese M, Tan F, Boonen A, Bessems-Beks M, Landewé R. Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial. Clinical Journal of Rheumatology 2013;32:199-209. - PubMed
Van Koulil 2010 {published data only}
    1. Van Koulil S, Van Lankveld W, Kraaimaat FW, Van Helmond T, Vedder A, Van Hoorn H, et al. Tailored cognitive-behavioral therapy and exercise training for high-risk patients with fibromyalgia. Arthritis Care and Research 2010;62:1377-85. - PubMed
Vitiello 2013 {published data only}
    1. Vitiello MV, McCurry SM, Shortreed SM, Balderson BH, Baker LD, Keefe FJ, et al. Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the Lifestyles randomized controlled trial. Journal of the American Geriatrics Society 2013;61:947-56. - PMC - PubMed
    1. Von Korff M, Vitiello MV, McCurry SM, Balderson BH, Moore AL, Baker LD, et al. Group interventions for co-morbid insomnia and osteoarthritis pain in primary care: the lifestyles cluster randomized trial design [Protocol]. Contemporary Clinical Trials 2012;33(4):759-68. - PMC - PubMed
Vlaeyen 1996 {published data only}
    1. Vlaeyen JW, Teeken-Gruben NJ, Goossens ME, Rutten-van Molken MP, Pelt RA, Eek H, et al. Cognitive-educational treatment of fibromyalgia: a randomized clinical trial. I. Clinical effects. Journal of Rheumatology 1996;23:1237-45. - PubMed
Wang 2018 {published data only}
    1. Wang J, Liang K, Sun H, Li L, Wang H, Cao J. Psychotherapy combined with drug therapy in patients withcategory III chronic prostatitis/chronic pelvic pain syndrome: Arandomized controlled trial. International Journal of Urology 2018;25:710-5. - PubMed
Wiklund 2018 {published data only}
    1. Wiklund T, Linton SJ, Alföldi P, Gerdle B. Is sleep disturbance in patients with chronic pain affected by physical exercise or ACT-based stress management? – A randomized controlled study. BMC Musculoskeletal Disorders 2018;19:111. - PMC - PubMed
Williams 1996 {published data only}
    1. Williams A, Richardson P, Nicholas M, Pither C, Harding VR, Ridout KL, et al. Inpatient vs. outpatient pain management: results of a randomised controlled trial. Pain 1996;66:13-22. - PubMed
Zautra 2008 {published data only}
    1. Zautra AJ, Davis MC, Reich JW, Nicassio P, Tennen H, Finan P, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. Journal of Consulting and Clinical Psychology 2008;76:408-21. - PubMed

References to studies excluded from this review

Bergdahl 1995 {published data only}
    1. Bergdahl J, Anneroth G, Perris H. Cognitive therapy in the treatment of patients with resistant burning mouth syndrome: a controlled study. Journal of Oral Pathology and Medicine 1995;24:213-5. - PubMed
Bourgault 2015 {published data only}
    1. Bourgault P, Lacasse A, Marchand S, Courtemanche-Harel R, Charest J, Gaumond I, et al. Multicomponent interdisciplinary group intervention for self-management of fibromyalgia: a mixed-methods randomized controlled trial. PLOS One 2015;10(5):e0126324. - PMC - PubMed
Broderick 2014 {published data only}
    1. Broderick JE, Keefe FJ, Bruckenthal P, Junghaenel DU, Schneider S, Schwartz JE, et al. Nurse practitioners can effectively deliver pain coping skills training to osteoarthritis patients with chronic pain: a randomized, controlled trial. Pain 2014;155:1743-54. - PMC - PubMed
Cederbom 2019 {published data only}
    1. Cederbom S, Leveille SG, Bergland A. Effects of a behavioral medicine intervention on pain, health, and behavior among community-dwelling older adults: a randomized controlled trial. Clinical Interventions in Aging 2019;14:1207-20. - PMC - PubMed
Chavooshi 2017a {published data only}
    1. Chavooshi B, Saberi M, Tavallaie SA, Sahraei H. Psychotherapy for medically unexplained pain: a randomized clinical trial comparing intensive short-term dynamic psychotherapy and cognitive-behavior therapy. Psychosomatics 2107;58:506-18. - PubMed
Chavooshi 2017b {published data only}
    1. Chavooshi B, Parvaneh Mohammadkhani P, Dolatshahee B. Telemedicine vs. in-person delivery of intensive short-term dynamic psychotherapy for patients with medically unexplained pain: a 12-month randomized, controlled trial. Journal of Telemedicine and Telecare 2017;23(1):133-41. - PubMed
Dedering 2018 {published data only}
    1. Dedering Å, Peolsson A, Cleland JA, Halvorsen M, Svensson MA, Kierkegaard M. The effects of neck-specific training versus prescribed physical activity on pain and disability in patients with cervical radiculopathy: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2018;99:2447-56. - PubMed
Ehrenborg 2010 {published data only}
    1. Ehrenborg C, Archenholtz B. Is surface EMG biofeedback an effective training method for persons with neck and shoulder complaints after whiplash-associated disorders concerning activities of daily living and pain - a randomized controlled trial. Clinical Rehabilitation 2010;24:715-26. - PubMed
Falcao 2008 {published data only}
    1. Falcão DM, Sales L, Leite JR, Feldman D, Valim V, Natour J. Cognitive behavioral therapy for the treatment of fibromyalgia syndrome: a randomized controlled trial. Journal of Musculoskeletal Pain 2008;16:133-40.
Gardiner 2019 {published data only}
    1. Gardiner P, Luo M, D'Amico S, Gergen-Barnett K, White LF, Saper R, Mitchell S, Liebschutz JM. Effectiveness of integrated medicine group visits in chronic pain and depressive symptoms: a randomized controlled trial. PLoS ONE 2019;14(12):e0225540. - PMC - PubMed
Garland 2013 {published data only}
    1. Garland EL, Howard MO. Mindfulness-oriented recovery enhancement reduces pain attentional bias in chronic pain patients. Psychotherapy and Psychosomatics 2013;82:311-8. - PubMed
Glombiewski 2018 {published data only}
    1. Glombiewski JA, Holzapfel S, Riecke J, Vlaeyen JW, Jong J, Lemmer G, et al. Exposure and CBT for chronic back pain: an RCT on differential efficacy and optimal length of treatment. Journal of Consulting and Clinical Psychology 2018;86(6):533-45. - PubMed
Godfrey 2020 {published data only}
    1. Godfrey E, Wileman V, Holmes MG, McCracken LM, Naughton S, Moss-Morris R, Noonan S, Barcellona M, Critchley D. Physical therapy informed by Acceptance and Commitment Therapy (PACT) versus usual care physical therapy for adults with chronic low back pain: a randomized controlled trial. Journal of Pain 2020;21(1-2):71-81. - PubMed
Gould 2020 {published data only}
    1. Gould HM, Atkinson JH, Chircop-Rollick T, D'Andrea J, Garfin S, Patel SM, Funk SD, Capparelli EV, Penzien DB, Wallace M, Weickgenanta AL, Slater M, Rutledge T. A randomized placebo-controlled trial of desipramine, cognitive behavioral therapy, and active placebo therapy for low back pain. Pain 2020;161(6):1341-9. - PubMed
Hammond 2001 {published data only}
    1. Hammond A, Freeman K. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology 2001;40:1044-51. - PubMed
    1. Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clinical Rehabilitation 2004;18:520-8. - PubMed
Harris 2017 {published data only}
    1. Harris A, Moe TF, Eriksen HR, Tangen T, Lie SA, Tveito TH, et al. Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (the CINS trial). European Journal of Pain 2017;21:1397-401. - PubMed
Haugli 2000 {published data only}
    1. Haugli L, Steen E, Lærum E, Finset A, Nygaard R. Agency orientation and chronic musculoskeletal pain: effects of a group learning program based on the personal construct theory. Clinical Journal of Pain 2000;16(4):281-9. - PubMed
Hirase 2018 {published data only}
    1. Hirase T, Kataoka H, Nakamo J, Inokuchi S, Sakamoto J, Okita M. Effects of a psychosocial intervention programme combined with exercise in community-dwelling older adults with chronic pain: a randomized controlled trial. European Journal of Pain 2018;22(3):592-600. - PubMed
Jensen 1997 {published data only}
    1. Jensen IB, Dahlquist C, Nygren A, Royen E, Stenberg M. Treatment for 'helpless' women suffering from chronic spinal pain: A randomized controlled 18-month follow-up study. Journal of Occupational Rehabilitation 1997;7(4):225-38.
Jørgensen 2011 {published data only}
    1. Jørgensen MB, Faber A, Hansen JV, Holtermann A, Søgaard K. Effects on musculoskeletal pain, work ability and sickness absence in a 1-year randomised controlled trial among cleaners. BMC Public Health 2011;11:840. - PMC - PubMed
Kerns 2014 {published data only}
    1. Kerns RD, Burns JW, Shulman M, Jensen MP, Nielson WR, Czlapinski R, et al. Can we improve cognitive–behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy. Health Psychology 2014;9:938-47. - PubMed
Lami 2018 {published data only}
    1. Lami MJ, Pilar Martínez M, Miró E, Sánchez AI, Pardos G, Cáliz R, Vlaeyen JWS. Efficacy of combined cognitive-behavioral therapy for insomnia and pain in patients with fibromyalgia: a randomized controlled trial. Cognitive Therapy & Research 2018;42:63-79.
Leeuw 2008 {published data only}
    1. Leeuw M, Goossens MEJB, Breukelen GJP, Jong JR, Heuts PHTG, Smeets RJEM, et al. Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial. Pain 2008;138(1):192-207. - PubMed
Linden 2014 {published data only}
    1. Linden M, Scherbe S, Cicholas B. Randomized controlled trial on the effectiveness of cognitive behavior group therapy in chronic back pain patients. Journal of Back and Musculoskeletal Rehabilitation 2014;27:563-8. - PubMed
Luciano 2011 {published data only}
    1. Luciano JV, Martínez N, Peña-Arrubia-María MT, Fernández-Vergel R, García-Campayo J, Verduras C, et al. Effectiveness of a psychoeducational treatment program implemented in general practice for fibromyalgia patients. A randomized controlled trial. Clinical Journal of Pain 2011;27:383-91. - PubMed
Mas 2019 {published data only}
    1. Mas RR, López-Jiménez T, Pujol-Ribeira E, Fernández-San Martín MI, Moix-Queraltó J, Montiel-Morillo E, et al. Effectiveness of a multidisciplinary biopsychosocial intervention for non-specific sub-acute low back pain in a working population: a cluster randomized clinical trial. BMC Health Services Research 2019;19:962. - PMC - PubMed
McCarberg 1999 {published data only}
    1. McCarberg B, Wolf J. Chronic pain management in a health maintenance organization. Clinical Journal of Pain 1999;15:50-7. - PubMed
Monticone 2012 {published data only}
    1. Monticone M, Baiardi P, Vanti C, Ferrari S, Nava T, Montironi C, et al. Chronic neck pain and treatment of cognitive and behavioural factors: results of a randomised controlled clinical trial. European Spine Journal 2012;21:1588-66. - PMC - PubMed
Mora 2013 {published data only}
    1. Mora MC, Weber D, Neff A, Rief W. Biofeedback-based cognitive-behavioral treatment compared with occlusal splint for temporomandibular disorder: a randomized controlled trial. Clinical Journal of Pain 2013;29(12):1057-65. - PubMed
Nicholas 2014 {published data only}
    1. Nicholas MK, Asghari A, Sharpe L, Brnabic A, Wood BM, Overton S, et al. Cognitive exposure versus avoidance in patients with chronic pain: adherence matters. European Journal of Pain 2014;18:424-37. - PubMed
Niedermann 2012 {published data only}
    1. Niedermann K, Buchi S, Ciurea A, Kubli R, Steurer-Stey C, Villiger PM, et al. Six and 12 months' effects of individual joint protection education in people with rheumatoid arthritis: a randomized controlled trial. Scandinavian Journal of Occupational Therapy 2012;19(4):360-9. - PubMed
Overmeer 2016 {published data only}
    1. Overmeer T, Peterson G, Ludvigsson ML, Peolsson A. The effect of neck-specific exercise with or without a behavioral approach on psychological factors in chronic whiplash-associated disorders: A randomized controlled trial with a 2-year follow-up. Medicine 2016;95(34):e4430. - PMC - PubMed
Pichette‐Leclerc 2017 {published data only}
    1. Pichette-Leclerc S, Dionne F, Pinard AM. Assessing the efficacy of a brief interdisciplinary program for chronic pain patients. Douleur et Analgésie 2017;30(4):250-7.
Racine 2018 {published data only}
    1. Racine M, Jensen MP, Harth M, Morley-Foster P, Nielson WR. Operant learning versus energy conservation activity pacing treatments in a sample of patients with fibromyalgia syndrome: a pilot randomized controlled trial. Journal of Pain 20;4:420-39. - PubMed
Schmidt 2011 {published data only}
    1. Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H. Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. Pain 2011;152:361-9. - PubMed
Siemonsma 2013 {published data only}
    1. Siemonsma PC, Stuive I, Roorde LD, Vollebregt JA, Walker MF, Lankhorst GJ, et al. Cognitive treatment of illness perceptions in patients with chronic low back pain: a randomized controlled trial. Physical Therapy 2013;93(4):435-45. - PubMed
Stenstrom 1994 {published data only}
    1. Stenstrom C. Home exercise in rheumatoid arthritis functional class II: goal setting versus pain attention. Journal of Rheumatology 1994;21(4):627-33. - PubMed
Tejedor 2015 {published data only}
    1. Tejedor CC, Requena GC, Palacios PL, Gonzáles AP, Roca LC, Puertas AG, et al. A multidisciplinary approach for patients with non-specific chronic low back pain: study protocol and preliminary findings.. 2015 15;3:433-42.
Torres 2018 {published data only}
    1. Torres E, Pedersen IN, Perez-Fernandez JI. Randomized trial of a group music and imagery method (GrpMI) for women with fibromyalgia. Journal of Music Therapy 2018;55(2):186-220. - PubMed
Turk 1996 {published data only}
    1. Turk DC, Rudy TE, Kubinski JA, Zaki HS, Greco CM. Dysfunctional patients with temporomandibular disorders: evaluating the efficacy of a tailored treatment protocol. Journal of Consulting and Clinical Psychology 1996;61(1):139-46. - PubMed
Vallabh 2015 {published data only}
    1. Vallabh PK, Rashiq S, Verrier MJ, Sanderman B, Dick BD. The effect of a cognitive-behavioral therapy chronic pain management program on perceived stigma: a clinical controlled trial. Journal of Pain Management 2015;7(4):291-9.
Vallejo 2015 {published data only}
    1. Vallejo MA, Ortega J, Rivera J, Comeche MI, Vallejo-Slocker L. Internet versus face-to-face group cognitive-behavioral therapy for fibromyalgia: a randomized control trial. Journal of Psychiatric Research 2015;68:106-13. - PubMed
Verkaik 2014 {published data only}
    1. Verkaik R, Busch M, Koeneman T, den Berg R, Spreeuwenberg P, Francke AL. Guided imagery in people with fibromyalgia:A randomized controlled trial of effects on pain, functional status and self-efficacy. Journal of Health Psychology 2014;19(5):678-88. - PubMed
Vibe Fersum 2013 {published data only}
    1. Vibe Fersum K, O’Sullivan P, Skouen JS, Smith A, Kvåle A. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. European Journal of Pain 2013;17:916-28. - PMC - PubMed
Wetherell 2011 {published data only}
    1. Wetherell JL, Afari N, Rutledge T, Sorrell JT, Stoddard JA, Petkus AJ, et al. A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain 2011;152:2098-107. - PubMed
Wippert 2020 {published data only}
    1. Wippert PM, Drießlein D, Beck H, Schneider C, Puschmann A-K, Banzer W, et al. The feasibility and effectiveness of a new practical multidisciplinary treatment for low-back pain: a randomized controlled trial. Journal of Clinical Medicine 2020;9:115. - PMC - PubMed
Woolfolk 2012 {published data only}
    1. Woolfolk RL, Allen LA, Apter JT. Affective-cognitive behavioral therapy for fibromyalgia: a randomized controlled trial. Pain Research and Treatment 2012;2012:937873. - PMC - PubMed

References to studies awaiting assessment

NCT00158275 {unpublished data only}
    1. NCT00158275. Combined interventions for treating depression and chronic back pain. ClinicalTrials.gov/show/NCT00158275 (first received September 2000).
NCT00176163 {unpublished data only}
    1. NCT00176163. Supporting effect of dronabinol on behavioral therapy in fibromyalgia and chronic back pain. ClinicalTrials.gov/show/NCT00176163 July 2001.
NCT00762125 {unpublished data only}
    1. NCT00762125. Subgroups of Fibromyalgia Syndrome (FMS): symptoms, beliefs, and tailored treatment. ClinicalTrials.gov/show/NCT00762125 November 2001.
NCT00982410 {unpublished data only}
    1. NCT00982410. Managing chronic pain in veterans with substance use disorders. ClinicalTrials.gov/show/NCT00982410 March 2006.

References to ongoing studies

NCT00830011 {unpublished data only}
    1. NCT00830011. Cognitive Behavioral Therapy for painful diabetic neuropathy. ClinicalTrials.gov/show/NCT00830011 August 2000.
NCT01993355 {unpublished data only}
    1. NCT01993355. Chronic low back pain: a multidisciplinary approach. ClinicalTrials.gov/show/NCT01993355 February 2009.

Additional references

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