© 2000 Evidence-Based Mental Health
Review: cognitive and behaviour therapies are effective for chronic pain
Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain 1999 Mar;80:1–13.[Medline]
QUESTIONS: In patients with chronic pain, excluding headache, how effective is psychological treatment (including cognitive behavioural therapy [CBT], behavioural therapy, and biofeedback), and is it more effective than alternative active treatments?
Studies were identified by searching 4 databases and scanning reference lists.
Selected studies were randomised controlled trials of cognitive behavioural treatments including behaviour therapy in adults who presented with chronic pain. Studies were excluded if they did not provide data for computing effect sizes.
Treatments were categorised into 3 primary types: biofeedback and relaxation, behaviour therapy, and CBT. Control groups were categorised as waiting list control and alternative treatment control. Because the studies had multiple measures, measurement domains were created: pain experience, mood or affect, cognitive coping and appraisal, pain behaviour, biology or physical fitness, social role functioning, use of healthcare system, and miscellaneous.
25 trials (1672 patients, mean age 58 y, 62% women) were included. Treatment was superior to waiting list control with significant effect sizes on all domains of measurement (table)
. The median effect size across all domains was 0.5. Among the 3 treatment subtypes, CBT was
Tavistock and Portman NHS Trust London, UK
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