An umbrella review of the literature on the effectiveness of psychological interventions for pain reduction, 2017, Markozannes et al.

[Trish]

An umbrella review of the literature on the effectiveness of psychological interventions for pain reduction

https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-017-0200-5

Abstract
Background
Psychological interventions are widely implemented for pain management and treatment, but their reported effectiveness shows considerable variation and there is elevated likelihood for bias.

Methods
We summarized the strength of evidence and extent of potential biases in the published literature of psychological interventions for pain treatment using a range of criteria, including the statistical significance of the random effects summary estimate and of the largest study of each meta-analysis, number of participants, 95% prediction intervals, between-study heterogeneity, small-study effects and excess significance bias.

Results
Thirty-eight publications were identified, investigating 150 associations between several psychological interventions and 29 different types of pain. Of the 141 associations based on only randomized controlled trials, none presented strong or highly suggestive evidence by satisfying all the aforementioned criteria. The effect of psychological interventions on reducing cancer pain severity, pain in patients with arthritis, osteoarthritis, rheumatoid arthritis, breast cancer, fibromyalgia, irritable bowel syndrome, self-reported needle-related pain in children/adolescents or with chronic musculoskeletal pain, chronic non-headache pain and chronic pain in general were supported by suggestive evidence.

Conclusions
The present findings reveal the lack of strong supporting empirical evidence for the effectiveness of psychological treatments for pain management and highlight the need to further evaluate the established approach of psychological interventions to ameliorate pain.

 

[Hutan]

Nice find @Trish
It's open access

However, the effect sizes across all meta-analyses are modest, only rising above a medium-size effect (i.e., standardised mean difference larger than 0.5) in lower quality studies [4]. The effectiveness of psychological treatments is shown to be over-estimated in poorly designed studies, and is reduced when controlled for quality and adjusted for potential bias [4, 13]. Thus, the reported heterogeneity in effect sizes is partly explained by the quality of the studies [13]. This observation is indicative of the possibility of bias in this literature, which could be due to publication or other selective reporting biases, where study authors employ several data collection and analysis techniques but publish only the most statistically significant findings

Umbrella review?

Because of the wide implementation of psychological interventions in pain management and the elevated likelihood for biases in this field as shown in prior relevant empirical research [19, 20], we used an umbrella review approach [21, 22] that systematically appraises the evidence on an entire field across many meta-analyses. In the present study we aimed to broaden the scope of a typical umbrella review by further evaluating the strength of the evidence and the extent of potential biases [23,24,25,26,27] on this body of literature.

 

[Trish]

Crossposted with Hutan.

Just came across this study from 4 years ago, and thought it was interesting in the light of ongoing problems with studies of psychological treatments for subjectively assessed symptoms such as pain and fatigue.

The authors point to lots of problems with systematic reviews including small studies, marginal statistical significance, poor quality studies included, etc.

 

[Arnie Pye]

The effect of psychological interventions on reducing cancer pain severity, pain in patients with arthritis, osteoarthritis, rheumatoid arthritis, breast cancer, fibromyalgia, irritable bowel syndrome, self-reported needle-related pain in children/adolescents or with chronic musculoskeletal pain, chronic non-headache pain and chronic pain in general were supported by suggestive evidence.

I don't find this systematic review convincing. I don't mean in terms of the conclusions (which I have no opinion on), but in the fact that they appear to be using a design for the review which compares oranges, eggs, and porridge. I have similar reservations about other systematic reviews and meta analyses that I've come across. It seems to be a way of coming to conclusions while getting further and further away from the source of the original data.

And on another point - what is "needle-related pain" and how does it become chronic? Are we talking about Type 1 diabetics here? or children with needle phobia?

 

[Trish]

My interest in this was not the individual outcomes in the systematic reviews they looked at but their recognition of the major flaws in all the systematic reviews. They were not drawing conclusions about particular therapies for particular pain conditions, but about the overall problem that none of the evidence really stood up to scrutiny for all sorts of reasons that systematic reviews tend to ignore.

 

[Arnie Pye]

@Trish

Sorry, I didn't mean to suggest that the paper shouldn't have been posted. I was grumbling about the very concept of a systematic review like this where conclusions are drawn from disparate papers about subject X, although I agree in this case that the conclusion could be beneficial to patients with many different conditions.

If I search for systematic reviews of statins, for example, I come across this absurd entry on DuckDuckGo :



This is the actual paper being referenced, for what it's worth, but it isn't really relevant to the point I'm making :

https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7135196/