Psychological therapies for managing pain after musculoskeletal injury may improve depression, but it is uncertain whether they reduce pain and functional improvement, according to a study published in Pain.
Previous randomized controlled trials concluded that psychological treatments for chronic pain effectively lower pain, functional impairment, and psychological distress. However, limited research is available to determine the efficacy of psychological treatments for pain after musculoskeletal injury. Thus, researchers conducted a systematic review and meta-analysis to review the efficacy of psychological treatments that target pain to improve primary and secondary outcomes after musculoskeletal injury and to summarize the gaps in the literature on this topic. Primary outcomes were pain intensity, functional impairment, depression symptoms, anxiety symptoms, PTSD symptoms, opioid consumption, patient ratings of global improvement, and adverse events. The secondary outcomes were treatment feasibility and treatment acceptability. A total of 39 papers that included 37 studies were included in the analysis. The mean age of the participants was 48.6 years and 60.5% were women.
A small beneficial effect of psychological therapies at reducing pain intensity posttreatment was found. A moderate beneficial effect was found for functional impairment, depression symptoms, anxiety symptoms, and PTSD symptoms. Insufficient evidence was found to group differences in opioid consumption and global improvement. No study reported any serious adverse events. The quality of evidence was low for all primary outcomes.
Among those assigned to psychological treatment for pain, posttreatment retention rates ranged from 57% to 100% compared with 49% to 100% among those assigned to the control condition.
Study limitations included the use of low-quality trials for the analysis.
Researchers concluded, “Owing to very low quality evidence, it is uncertain whether psychological treatment for pain has a beneficial effect on pain intensity and functional
impairment immediately posttreatment, although evidence suggested a possible positive treatment effect of depression and PTSD.”
Aaron RV, Rassu FS, Wegener ST, et al. Psychological treatments for the management of pain after musculoskeletal injury: a systematic review and meta-analysis. Pain. Published online July 25, 2023. doi:10.1097/j.pain.0000000000002991