Psychological therapies for the management of chronic neuropathic pain in adults

Christopher Eccleston, Leslie Hearn, Amanda C de C Williams, Christopher Eccleston, Leslie Hearn, Amanda C de C Williams

Abstract

Background: Neuropathic pain is thought to arise from damage to the somatosensory nervous system. Its prevalence is increasing in line with many chronic disorders such as diabetes. All treatments have limited effectiveness. Given the evidence regarding psychological treatment for distress and disability in people with various chronic pain conditions, we were interested to investigate whether psychological treatments have any effects for those with chronic neuropathic pain.

Objectives: To assess the effects of psychological treatments on pain experience, disability, mood, and health-care use in adults with chronic neuropathic pain.

Search methods: We searched for randomised controlled trials (RCTs) published in any language in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO, from database inception to March 2015.

Selection criteria: Full publications of RCTs on psychological interventions for neuropathic pain. Trials had to have lasted at least three months, had at least 20 participants in each arm at the end of treatment, and compared a psychological intervention with any active or inactive intervention.

Data collection and analysis: We used the standard methodological procedures expected by Cochrane.

Main results: Two small studies (enrolling a total of 105 participants) met the inclusion criteria. One was a standard cognitive behavioural treatment (CBT) programme for 61 people with pain from spinal cord injury, followed up for three months, and compared with a waiting list. The other was weekly group psychotherapy for 44 people with burning mouth syndrome, compared with a daily placebo tablet. The overall risk of bias was high in both trials.The CBT study assessed participants for pain, disability, mood, and quality of life, with improvement in treatment and control groups. However, there was no more improvement in the treatment group than in the control for any outcome, either post-treatment or at follow-up. The group psychotherapy study only assessed pain, classifying participants by pain severity. There is a lack of evidence on the efficacy and safety of psychological interventions for people with neuropathic pain.

Authors' conclusions: There is insufficient evidence of the efficacy and safety of psychological interventions for chronic neuropathic pain. The two available studies show no benefit of treatment over either waiting list or placebo control groups.

Conflict of interest statement

Christopher Eccleston (CE) receives funding support from the UK National Institute for Health Research for work on a series of reviews informing the unmet need of chronic pain and providing the evidence for treatments of pain. This title is part of this research programme. Since CE is an author as well as the PaPaS Co‐ordinating Editor at the time of writing, we acknowledge the input of Andrew Moore who acted as Sign Off Editor for this review. CE had no input into the editorial decisions or processes for this review.

Leslie Hearn: none known.

Amanda Williams: none known.