Over the last 10 years, the prevention of the transition from acute to chronic pain has raised growing interest in the pain community. It can be explained by the acknowledgement of individual and social consequences of chronic pain, a better understanding of the physiopathological mechanisms as well as the identification of associated risk factors. Many psychological risk factors are now known to contribute to the development of chronic pain such as anxiety, depression, catastrophization (dramatization) and kinesiophobia, the fear of engaging in certain movements.
Goal
Researchers therefore investigated the efficacy of psychological interventions to prevent chronic pain. The research team assed the impact of randomized controlled trials evaluating psychological interventions on pain intensity within 3 months after pain onset, compared to the usual treatments, provision of information or supportive interventions. The researchers also evaluated the impact of these intervention on pain-related disability, anxiety and depressive symptoms, pain catastrophizing, kinesiophobia, pain self-efficacy, quality of life, social impact such as healthcare utilization and return to work as well as adverse effects.
Methodology
The team searched randomized controlled clinical studies in five databases. No language or date limitations were applied to the search. Studies were conducted on adults 18 years old or older with non-cancer pain for less than three months. Psychological interventions had to fit the following definitions: cognitive-behavioral approaches including psychoeducation, self-management interventions, hypnotherapy, acceptance and commitment interventions, and mindfulness-based stress reduction interventions. Two independent reviewers screened and assessed the studies’ eligibility, extracted relevant data, assessed the studies’ methodological quality and the evidence related to the outcomes being evaluated.
Main findings
A total of 18 studies were included. Studies had slightly more women than men and most were conducted with middle-aged to older adults with back pain. There was no significant effect of psychological interventions on pain intensity and psychological outcomes such as anxiety and depression within 3 months after pain onset. A moderate effect on pain-related disability at 12 months was demonstrated when the psychological interventions were compared with standard treatments. Additionally, a small effect was demonstrated on pain efficacy at 3 months when psychological interventions were compared with provision of information. A high risk of bias was found in most of the studies included. Also, the outcomes assessed were based on low quality evidence due to study bias and variability in results across studies. This means that it’s very likely that further research will impact our trust in the results obtained in this study.
Take home message
This systematic review emphasized that there’s a lack of evidence needed to elucidate the role of psychological interventions that prevent the transition from acute to chronic pain. Some positive results were identified regarding the interventions’ effect on disability and self-efficacy of pain management, but these need to be confirmed by further research. Additional high-quality studies including patients at high-risk for chronic pain would improve our understanding of psychological interventions efficiency in preventing this type of pain.
