Background & Aims

Chronic non-cancer pain is a widespread issue, causing heightened pain catastrophizing and hindering effective self-management. Cognitive therapy has emerged as a promising intervention to modify maladaptive thoughts and beliefs. Short-term cognitive/educational therapy can be feasibly integrated into individuals’ lives and is less time consuming. This systematic review aimed at exploring the efficacy of cognitive and educational interventions of short-term application which could potentially be offered to people in the waiting period for specialized pain treatment addressing psychological aspects of pain management with special focus on pain catastrophizing.

Methods

Search strategy was built based on the PICOS criteria. Searches were performed on PubMed/ Medline, Embase, Central, Web of Science, Cinahl and Psycinfo on articles published until June 2023. Inclusion criteria were: Adult age > 18 years old with chronic non-cancer pain, cognitive therapy/ educational intervention for a maximum period of 4 weeks, measuring of pain catastrophizing, randomized controlled trials. Exclusion criteria were: Children or adolescent, cancer pain, acute pain, headache, migraine, pharmacological interventions, or invasive interventions. Two reviewers screened and selected the articles. Doubts were solved by discussion with senior researcher. Data extraction and synthesis followed PRISMA guidelines, employing SWiM due to study heterogeneity. Key features and findings were organized, with a focus on the Pain Catastrophizing Scale as the primary outcome measure. Quality assessment used the Cochrane Risk of Bias tool.

Results

A comprehensive literature search yields 6691 articles using the Covidence screening tool, with 96 meeting inclusion criteria and five ultimately included. The studies, conducted between 2016 and 2021 in the USA and the UK, feature participants with various chronic non-cancer pain conditions. Interventions include Cognitive Behavioral Therapy and Pain Neuroscience Education. The result reveals positive trends in reducing pain catastrophizing. However, discrepancies were observed in the primary outcomes and follow-up time points, with 4 studies showing a significant positive effect in pain catastrophizing at follow-up; these studies were classified as both high and low methodological quality. Only 2 studies showed positive effects of the intervention when compared to control group; these studies were classified as high methodological quality.

Conclusions

The evidence supports the effectiveness of short-term interventions like CBT, Behavioral Therapy, Acceptance and Commitment Therapy, and Pain Neuroscience Education. However, methodological heterogeneity and concerns about bias in some studies warrant caution in definitive conclusions. While acknowledging the promise of short-term cognitive interventions, the review calls for standardized methodologies in future research to enhance understanding and guide effective pain management strategies for individuals with chronic non-malignant pain.

References

Presenting Author

Mark Puch Oernskov

Poster Authors

Mark Puch Oernskov

PhD student, MHS, Nurse

Neuroscience Center, Rigshospitalet Copenhagen University Hospital

Lead Author

Topics

  • Systematic Reviews/Meta-Analysis