Meta-analysis of psychosocial interventions to reduce pain in patients with cancer

Sherri Sheinfeld Gorin, Paul Krebs, Hoda Badr, Elizabeth Amy Janke, Heather S L Jim, Bonnie Spring, David C Mohr, Mark A Berendsen, Paul B Jacobsen, Sherri Sheinfeld Gorin, Paul Krebs, Hoda Badr, Elizabeth Amy Janke, Heather S L Jim, Bonnie Spring, David C Mohr, Mark A Berendsen, Paul B Jacobsen

Abstract

Purpose: Pain is one of the most common, burdensome, and feared symptoms experienced by patients with cancer. American Pain Society standards for pain management in cancer recommend both pharmacologic and psychosocial approaches. To obtain a current, stable, and comprehensive estimate of the effect of psychosocial interventions on pain-an important clinical topic-we conducted a meta-analysis of randomized controlled studies among adult patients with cancer published between 1966 and 2010.

Methods: Three pairs of raters independently reviewed 1,681 abstracts, with a systematic process for reconciling disagreement, yielding 42 papers, of which 37 had sufficient data for meta-analysis. Studies were assessed for quality using a modified seven-item Physiotherapy Evidence Database (PEDro) coding scheme. Pain severity and interference were primary outcome measures.

Results: Study participants (N = 4,199) were primarily women (66%) and white (72%). The weighted averaged effect size across studies for pain severity (38 comparisons) was 0.34 (95% CI, 0.23 to 0.46; P < .001), and the effect size for pain interference (four comparisons) was 0.40 (95% CI, 0.21 to 0.60; P < .001). Studies that monitored whether treatment was delivered as intended had larger effects than those that did not (P = .04).

Conclusion: Psychosocial interventions had medium-size effects on both pain severity and interference. These robust findings support the systematic implementation of quality-controlled psychosocial interventions as part of a multimodal approach to the management of pain in patients with cancer.

Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Selection of included studies.
Fig 2.
Fig 2.
Forest plot of effect sizes (g) for studies measuring pain severity (k = 38).
Fig 3.
Fig 3.
Funnel plot of effect sizes by standard error for pain severity.

References

    1. van den Beuken-van Everdingen M Derijke J Kessels AG , etal: Prevalence of pain in patients with cancer: A systematic review of the past 40 years Ann Oncol 18: 1437– 1449,2007
    1. McGuire D: Occurrence of cancer pain J Natl Cancer Inst Monogr 32: 51– 56,2004
    1. Allard P Maunsell E Labbé J , etal: Educational interventions to improve cancer pain control: A systematic review J Palliat Med 4: 191– 203,2001
    1. Miaskowski C, Cleary J: Guidelines for the Management of Cancer Pain in Adults and Children 2005. Glenview, IL: American Pain Society
    1. Gordon DB Dahl JL Miaskowski C , etal: American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force Arch Intern Med 165: 1574– 1580,2005
    1. Borenstein M Hedges L Higgins J , etal: Introduction to Meta-Analysis 2009. Chichester, United Kingdom: Wiley
    1. Bennett MI, Bagnall AM, Jose Closs S: How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis Pain 143: 192– 199,2009
    1. Devine EC, Westlake SK: The effects of psychoeducational care provided to adults with cancer Oncol Nurs Forum 22: 1369– 1381,1995
    1. Devine EC: Meta-analysis of the effect of psychoeducational interventions on pain in adults with cancer Oncol Nurs Forum 30: 75– 89,2003
    1. Luebbert K, Dahme B, Hasenbring M: The effectiveness of relaxational training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: A meta-analytical review Psychooncology 10: 490– 502,2001
    1. Tatrow K, Montgomery GH: Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: A meta-analysis J Behav Med 29: 17– 27,2006
    1. Verhagen AP De Vet HCW De Bie RA , etal: The Delphi list: A criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus J Clin Epidemiol 51: 1235– 1241,1998
    1. Lipsey MW, Wilson DB: Practical Meta-Analysis 2001. Thousand Oaks, CA: Sage
    1. Duval S, Tweedie R: Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis Biometrics 56: 455– 463,2000
    1. Wells N Hepworth JT Murphy BA , etal: Improving cancer pain management through patient and family education J Pain Symptom Manage 25: 344– 356,2003
    1. Kalauokalani D Franks P Oliver JW , etal: Can patient coaching reduce racial/ethnic disparities in cancer pain control? Secondary analysis of a randomized controlled trial Pain Med 8: 17– 24,2007
    1. Given BA Given CW Jeon S , etal: Effect of neutropenia on the impact of a cognitive-behavioral intervention for symptom management Cancer 104: 869– 878,2005
    1. Domar AD, Noe JM, Benson H: The preoperative use of the relaxation response with ambulatory surgery patients J Human Stress 13: 101– 107,1987
    1. Dalton JA Keefe FJ Carlson J , etal: Tailoring cognitive-behavioral treatment for cancer pain Pain Manag Nurs 5: 3– 18,2004
    1. Syrjala KL, Cummings C, Donaldson GW: Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: A controlled clinical trial Pain 48: 137– 146,1992
    1. Allard N: Day surgery and recovery in women with a suspicious breast lesion: Evaluation of a psychoeducational nursing intervention Can Oncol Nurs J 16: 137– 153,2006
    1. Anderson KO Mendoza TR Payne R , etal: Pain education for underserved minority cancer patients: A randomized controlled trial J Clin Oncol 22: 4918– 4925,2004
    1. Arathuzik D: Effects of cognitive-behavioral strategies on pain in cancer patients Cancer Nurs 17: 207– 214,1994
    1. Bozcuk H Kolagasi O Samur M , etal: A brief information sheet on opioid effects improves quality of life in cancer patients on opioids Internet J Pain Symptom Control Palliat Care
    1. Chang MC Chang YC Chiou JF , etal: Overcoming patient-related barriers to cancer pain management for home care patients: A pilot study Cancer Nurs 25: 470– 476,2002
    1. Changrani J Lieberman M Golant M , etal: Online cancer support groups: Experiences with underserved immigrant Latinas Prim Psychiatry 15: 55– 62,2008
    1. Dalton JA: Education for pain management: A pilot study Patient Educ Couns 9: 155– 165,1987
    1. de Wit R van Dam F Zandbelt L , etal: A pain education program for chronic cancer pain patients: Follow-up results from a randomized controlled trial Pain 73: 55– 69,1997
    1. de Wit R, van Dam F: From hospital to home care: A randomized controlled trial of a pain education programme for cancer patients with chronic pain J Adv Nurs 36: 742– 754,2001
    1. de Wit R van Dam F Loonstra S , etal: Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain Eur J Pain 5: 241– 256,2001
    1. Ebell H: The therapist as a travelling companion to the chronically ill: Hypnosis and cancer related symptoms Contemp Hypnosis 25: 46– 56,2008
    1. Ferrell BR, Rhiner M, Ferrell BA: Development and implementation of a pain education program Cancer 72: 3426– 3432,1993
    1. Gaston-Johansson F Fall-Dickson JM Nanda J , etal: The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation Cancer Nurs 23: 277– 285,2000
    1. Goodwin PJ Leszcz M Ennis M , etal: The effect of group psychosocial support on survival in metastatic breast cancer N Engl J Med 345: 1719– 1726,2001
    1. Keefe FJ Ahles TA Sutton L , etal: Partner-guided cancer pain management at the end of life: A preliminary study J Pain Symptom Manage 29: 263– 272,2005
    1. Kroenke K Theobald D Wu J , etal: Effect of telecare management on pain and depression in patients with cancer: A randomized trial JAMA 304: 163– 171,2010
    1. Kwekkeboom KL: Music versus distraction for procedural pain and anxiety in patients with cancer Oncol Nurs Forum 30: 433– 440,2003
    1. Kwekkeboom KL, Wanta B, Bumpus M: Individual difference variables and the effects of progressive muscle relaxation and analgesic imagery interventions on cancer pain J Pain Symptom Manage 36: 604– 615,2008
    1. Lai YH Guo SL Keefe FJ , etal: Effects of brief pain education on hospitalized cancer patients with moderate to severe pain Support Care Cancer 12: 645– 652,2004
    1. Lang EV Berbaum KS Pauker SG , etal: Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: When being nice does not suffice J Vasc Interv Radiol 19: 897– 905,2008
    1. Lin CC Chou PL Wu SL , etal: Long-term effectiveness of a patient and family pain education program on overcoming barriers to management of cancer pain Pain 122: 271– 281,2006
    1. Miaskowski C Dodd M West C , etal: Randomized clinical trial of the effectiveness of a self-care intervention to improve cancer pain management J Clin Oncol 22: 1713– 1720,2004
    1. Montgomery GH Weltz CR Seltz M , etal: Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients Int J Clin Exp Hypn 50: 17– 32,2002
    1. Montgomery GH Bovbjerg DH Schnur JB , etal: A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients J Natl Cancer Inst 99: 1304– 1312,2007
    1. Oliver JW Kravitz RL Kaplan SH , etal: Individualized patient education and coaching to improve pain control among cancer outpatients J Clin Oncol 19: 2206– 2212,2001
    1. Rimer B Levy MH Keintz MK , etal: Enhancing cancer pain control regimens through patient education Patient Educ Couns 10: 267– 277,1987
    1. Sloman R Brown P Aldana E , etal: The use of relaxation for the promotion of comfort and pain relief in persons with advanced cancer Contemp Nurse 3: 6– 12,1994
    1. Spiegel D, Bloom JR: Group therapy and hypnosis reduce metastatic breast carcinoma pain Psychosom Med 45: 333– 339,1983
    1. Syrjala KL Donaldson GW Davis MW , etal: Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: A controlled clinical trial Pain 63: 189– 198,1995
    1. Syrjala KL Abrams JR Polissar NL , etal: Patient training in cancer pain management using integrated print and video materials: A multisite randomized controlled trial Pain 135: 175– 186,2008
    1. Tsai PS Chen PL Lai YL , etal: Effects of electromyography biofeedback-assisted relaxation on pain in patients with advanced cancer in a palliative care unit Cancer Nurs 30: 347– 353,2007
    1. Vallières I Aubin M Blondeau L , etal: Effectiveness of a clinical intervention in improving pain control in outpatients with cancer treated by radiation therapy Int J Radiat Oncol Biol Phys 66: 234– 237,2006
    1. Ward S Donovan HS Owen B , etal: An individualized intervention to overcome patient-related barriers to pain management in women with gynecologic cancers Res Nurs Health 23: 393– 405,2000
    1. Ward S Donovan H Gunnarsdottir S , etal: A randomized trial of a representational intervention to decrease cancer pain (RIDcancerPain) Health Psychol 27: 59– 67,2008
    1. Yates P Edwards H Nash R , etal: A randomized controlled trial of a nurse-administered educational intervention for improving cancer pain management in ambulatory settings Patient Educ Couns 53: 227– 237,2004
    1. Anderson KO Cohen MZ Mendoza TR , etal: Brief cognitive-behavioral audiotape interventions for cancer-related pain: Immediate but not long-term effectiveness Cancer 107: 207– 214,2006
    1. Lohr JM, DeMaio C, McGlynn FD: Specific and nonspecific treatment factors in the experimental analysis of behavioral treatment efficacy Behav Modif 27: 322– 368,2003
    1. Curtis JR, Levy MM: Improving the science and politics of quality improvement JAMA 305: 406– 407,2011
    1. Berwick DM: A user's manual for the IOM's “Quality Chasm” report Health Aff 21: 89– 90,2002
    1. Institute of Medicine: Relieving pain in America: A blueprint for transforming prevention, care, education, and research. .
    1. Institute of Medicine: Washington, DC: National Academies Press; 2001. Crossing the Quality Chasm: A New Health System for the 21st Century.
    1. Institute of Medicine: Washington, DC: National Academies Press; 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
    1. National Cancer Institute, Division of Cancer Control and Population Sciences: Grid-Enabled Measures Database.
    1. McNicol E Strassels S Goudas L , etal: Nonsteroidal anti-inflammatory drugs, alone or combined with opioids, for cancer pain: A systematic review J Clin Oncol 22: 1975– 1992,2004
    1. US Food and Drug Administration: Strategic priorities: Strategic goals and long-term objectives. .

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