What psychological interventions are effective for the management of (PPS)? A systematic review and meta-analysis, 2022, Swainston et al

[Andy]

Full title: What psychological interventions are effective for the management of persistent physical symptoms (PPS)? A systematic review and meta-analysis

Abstract

Objectives
Presentation of persistent physical symptoms is associated with increased health care utilization, yet clinical outcomes often remain suboptimal. This systematic review aimed to determine whether psychological interventions are effective for the management of PPS and if so, what are the features of the interventions and at what level of care are they delivered. The review also set out to establish which symptoms in those diagnosed with PPS can be effectively managed with psychological intervention.

Methods
Studies were included if they clearly reported a psychological intervention, specified the study sample as adults with a diagnosis of persistent physical symptoms, included a comparator and as a minimum an outcome measure of somatic symptoms. Risk of bias was assessed using the EPHPP. Meta-analysis was conducted to estimate the overall effect of interventions on somatic symptoms (the primary outcome), anxiety and depression (secondary outcomes).

Results
Seventeen papers of varying quality indicated that psychological interventions can be effective for the management of somatic symptoms reported by individuals with PPS within a primary care setting. Psychological interventions were also found to be effective at reducing depression symptoms in individuals with PPS in twelve of the included studies. However, the meta-analysis results suggest that the psychological interventions utilized within eleven of the included studies did not significantly impact anxiety symptoms.

Conclusions
Psychological interventions have some success in managing somatic symptoms in PPS patients within primary care settings although their effects on other psychological symptoms is more mixed. The review highlights the importance of establishing a clearer diagnostic classification to inform treatment trajectories and the need for appropriate training and support within a multi-disciplinary team to enable the provision of such therapies.

Open access, https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjhp.12613

 

[NelliePledge]

First paragraph of background quotes “PPS” as 20% of gp consultations and 52% of specialist referrals @dave30th bete noir of Bermingham also quoted

 

[chrisb]

Effective for whom? The patient or the doctor?

 

[Hutan]

Our data support the use of psychological interventions delivered in primary care as an approach to reduce somatic and depression symptoms rather than a dualistic approach for treatment of PPS. Many of the included studies adopted a CBT approach and Deary et al. (2007) have developed a CBT model of MUS, whereby the patient is challenged on the origins of symptoms such as pain or fatigue and perpetuates their own illness by holding on to beliefs in an ‘organic’ illness. While the data showed no heterogeneity between type of intervention (CBT and non-CBT) the results are promising for the development of psychological interventions incorporating a cognitive behavioural component.

2022, and it's still only "promising".

 

[Sean]

The review highlights the importance of establishing a clearer diagnostic classification to inform treatment trajectories and the need for appropriate training and support within a multi-disciplinary team to enable the provision of such therapies.

I notice there is no mention of using more robust outcome measures.

 

[rvallee]

2022, and it's still only "promising".

After years of being used commonly in many countries, adding up to hundreds of thousands. With no actual assessment of outcomes from clinical practice, while some are literally still doing single case studies. It's standard treatment that has been "promising" for half a century, for conditions that switch back and forth between not existing and being commonly treated.

It's basically established that funding for this is only limited by how much is provided each year, but that every year will bring more money to do the same things, say the same things and always conclude that it's promising and needs more research. The money is guaranteed, results are irrelevant, no one even cares that no progress is being made at all.

Why would they even care to do anything else? They can put in zero effort and get funding anyway. They can fail miserably and get promoted for it. Hell, there probably have been a thousand trials already and it would be hard to tell, since most are so pathetic in scope that they go unnoticed while many are simply never published.

The existence of the BPS model serves only to make excuses for medicine's failures to make progress. And save money to governments and insurers. Sick people aren't the beneficiaries, we're the sacrificial lambs.