Cited by 1,634Musculoskeletal pain and rehabilitationPain Management and TreatmentMindfulness and Compassion Interventions

The DOI matches its Crossref record; 295 of the 295 references it cites were found in a registry or an index; none of the 38 sources its claims cite is checked for support yet.

Psychological therapies for the management of chronic pain (excluding headache) in adults

Open access

Williams, Amanda C de C, Eccleston, Christopher, Morley, Stephen·2012·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd007407.pub3PMC PMC6483325

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Abstract

BACKGROUND: Chronic non-cancer pain, a disabling and distressing condition, is common in adults. It is a global public health problem and economic burden on health and social care systems and on people with chronic pain. Psychological treatments aim to reduce pain, disability and distress. This review updates and extends its previous version, published in 2012. OBJECTIVES: To determine the clinical efficacy and safety of psychological interventions for chronic pain in adults (age > 18 years) compared with active controls, or waiting list/treatment as usual (TAU). SEARCH METHODS: We identified randomised controlled trials (RCTs) of psychological therapies by searching CENTRAL, MEDLINE, Embase and PsycINFO to 16 April 2020. We also examined reference lists and trial registries, and searched for studies citing retrieved trials. SELECTION CRITERIA: RCTs of psychological treatments compared with active control or TAU of face-to-face therapies for adults with chronic pain. We excluded studies of headache or malignant disease, and those with fewer than 20 participants in any arm at treatment end. DATA COLLECTION AND ANALYSIS: Two or more authors rated risk of bias, extracted data, and judged quality of evidence (GRADE). We compared cognitive behavioural therapy (CBT), behavioural therapy (BT), and acceptance and commitment therapy (ACT) with active control or TAU at treatment end, and at six month to 12 month follow-up. We did not analyse the few trials of other psychological treatments. We assessed treatment effectiveness for pain intensity, disability, and distress. We extracted data on adverse events (AEs) associated with treatment. MAIN RESULTS: We added 41 studies (6255 participants) to 34 of the previous review's 42 studies, and now have 75 studies in total (9401 participants at treatment end). Most participants had fibromyalgia, chronic low back pain, rheumatoid arthritis, or mixed chronic pain. Most risk of bias domains were at high or unclear risk of bias, with selective reporting and treatment expectations mostly at unclear risk of bias. AEs were inadequately recorded and/or reported across studies. CBT The largest evidence base was for CBT (59 studies). CBT versus active control showed very small benefit at treatment end for pain (standardised mean difference (SMD) -0.09, 95% confidence interval (CI) -0.17 to -0.01; 3235 participants; 23 studies; moderate-quality evidence), disability (SMD -0.12, 95% CI -0.20 to -0.04; 2543 participants; 19 studies; moderate-quality evidence), and distress (SMD -0.09, 95% CI -0.18 to -0.00; 3297 participants; 24 studies; moderate-quality evidence). We found small benefits for CBT over TAU at treatment end for pain (SMD -0.22, 95% CI -0.33 to -0.10; 2572 participants; 29 studies; moderate-quality evidence), disability (SMD -0.32, 95% CI -0.45 to -0.19; 2524 participants; 28 studies; low-quality evidence), and distress (SMD -0.34, 95% CI -0.44 to -0.24; 2559 participants; 27 studies; moderate-quality evidence). Effects were largely maintained at follow-up for CBT versus TAU, but not for CBT versus active control. Evidence quality for CBT outcomes ranged from moderate to low. We rated evidence for AEs as very low quality for both comparisons. BT We analysed eight studies (647 participants). We found no evidence of difference between BT and active control at treatment end (pain SMD -0.67, 95% CI -2.54 to 1.20, very low-quality evidence; disability SMD -0.65, 95% CI -1.85 to 0.54, very low-quality evidence; or distress SMD -0.73, 95% CI -1.47 to 0.01, very low-quality evidence). At follow-up, effects were similar. We found no evidence of difference between BT and TAU (pain SMD -0.08, 95% CI -0.33 to 0.17, low-quality evidence; disability SMD -0.02, 95% CI -0.24 to 0.19, moderate-quality evidence; distress SMD 0.22, 95% CI -0.10 to 0.54, low-quality evidence) at treatment end. At follow-up, we found one to three studies with no evidence of difference between BT and TAU. We rated evidence for all BT versus active control outcomes as very low quality; for BT versus TAU. Evidence quality ranged from moderate to very low. We rated evidence for AEs as very low quality for BT versus active control. No studies of BT versus TAU reported AEs. ACT We analysed five studies (443 participants). There was no evidence of difference between ACT and active control for pain (SMD -0.54, 95% CI -1.20 to 0.11, very low-quality evidence), disability (SMD -1.51, 95% CI -3.05 to 0.03, very low-quality evidence) or distress (SMD -0.61, 95% CI -1.30 to 0.07, very low-quality evidence) at treatment end. At follow-up, there was no evidence of effect for pain or distress (both very low-quality evidence), but two studies showed a large benefit for reducing disability (SMD -2.56, 95% CI -4.22 to -0.89, very low-quality evidence). Two studies compared ACT to TAU at treatment end. Results should be interpreted with caution. We found large benefits of ACT for pain (SMD -0.83, 95% CI -1.57 to -0.09, very low-q

AI snapshot

Written from the paper’s full text.

TL;DR

This Cochrane review found that cognitive behavioural therapy (CBT) has small-to-moderate benefits for chronic pain in adults, especially compared with treatment as usual or waiting list, while evidence for behaviour therapy is weak and sparse. Effects were strongest for mood and catastrophic thinking, with smaller effects on disability and pain.

Key findings

The review included 42 trials; 35 provided usable data, with 4788 treated participants providing post-treatment data from 5424 starting treatment. Mean study quality was 21.2/35 overall, 15.8/26 for design, and 5.4/9 for treatment quality.
CBT versus active control: disability improved post-treatment (SMD -0.19, 95% CI -0.33 to -0.05; 12 studies, 1130 participants) and at follow-up (SMD -0.15, 95% CI -0.28 to -0.02; 12 studies, 1295 participants); catastrophising improved post-treatment (SMD -0.18, 95% CI -0.36 to 0.00; 6 studies, 735 participants). Pain and mood were not significant.
CBT versus treatment as usual/waiting list: significant post-treatment effects were found for pain (SMD -0.21, 95% CI -0.37 to -0.05; 16 studies, 1148 participants), disability (SMD -0.26, 95% CI -0.47 to -0.04; 15 studies, 1105 participants), mood (SMD -0.38, 95% CI -0.57 to -0.18; 12 studies, 899 participants), and catastrophising (SMD -0.53, 95% CI -0.76 to -0.31; 5 studies, 308 participants). At follow-up, only mood was just significant (SMD -0.26, 95% CI -0.51 to 0.00; 7 studies, 637 participants).
Behaviour therapy versus treatment as usual showed no significant post-treatment effects on pain, disability, or mood; catastrophising was just significant (SMD -0.72, 95% CI -1.43 to -0.01; 3 studies, 269 participants) but with high heterogeneity (I² = 84%). There were insufficient studies for meta-analysis of behaviour therapy versus active control.

Methods

Systematic review and meta-analysis of RCTs in adults aged 18 years or older with non-malignant chronic pain of at least three months’ duration, excluding headache or migraine. Trials compared a credible psychological treatment with placebo, active treatment, treatment as usual, or waiting list control, and required at least 20 participants per treatment arm at post-treatment assessment.
Searches covered CENTRAL, MEDLINE, EMBASE, and Psychlit from inception to September 2011, with no language restrictions. Two treatment classes were analysed: CBT and behavioural therapy; comparators were active control and treatment as usual/waiting list.
Outcomes were pain, disability, mood, and catastrophic thinking at post-treatment and follow-up (at least six months and not more than 12 months after treatment). Treatment effects were estimated using standardised mean differences, with heterogeneity assessed by Chi² and I²; risk of bias and the Yates quality scale were applied.

Limitations

The paper states that no data were available on adverse events, withdrawal and escape, or emergency analgesia; no dichotomous outcomes were reported, so no numbers needed to treat were calculated; no adjustment for reliability of measures was made; and planned subgroup analyses on doses and different conditions were not undertaken due to lack of data.
The review reports high heterogeneity in many analyses, especially for behaviour therapy, and notes that most high risk-of-bias judgements were due to inadequate reporting. Treatment quality did not improve over time, and average effects may mask larger changes in some patients and little or none in others.
Evident from the text: behaviour therapy comparisons were often based on only one or two studies, limiting power; control classification of treatment as usual/waiting list was described as not entirely satisfactory; and the review could not resolve whether the psychotherapeutic content of existing trials was adequate.

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Crossref · 10.1002/14651858.cd007407.pub3

Cites

295 of 295 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

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Show all 123 claims

It may state two separate claims as one. 47
Probably not a substantial claim. 168
The quote only partly states this claim. 4

In the paper
“and reduced it to 9% (Analysis 4.3) but also produced a non-significant result in place of the just significant one: Z was 1.57, P > 0.05.”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Heterogeneity inspection
What the sources say
- Not checked yetcites Van Koulil 2010 source
Load-bearingStrength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
In the paper
“In Analysis 3.2, heterogeneity was reduced to 55% by the removal of one positive outlier (Williams 1996), without affecting the overall significant result.”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Heterogeneity inspection
What the sources say
- Not checked yetcites Williams 1996 source
Strength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“In Analysis 7.4, again removal of a single study (Thieme 2003) reduced heterogeneity to 0% and strengthened the result, although this was now only produced by two studies: Z = 2.41 P < 0.05; the effect size was SMD -0.34 (95% CI -0.62 to -0.06).”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Heterogeneity inspection
What the sources say
- Not checked yetcites Thieme 2003 source
Strength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“but the Yates 2005 treatment subscale is restricted to five items so may be relatively insensitive.”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > D I S C U S S I O N Evidence base
What the sources say
- Not checked yetcites Yates 2005 source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“In Analysis 4.2 and Analysis 4.3, removal of a single study (Van Koulil 2010) reduced heterogeneity to 0% but without changing the non-significant result (Analysis 4.2)”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Heterogeneity inspection
What the sources say
- Not checked yetcites Van Koulil 2010 source
Strength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“Compared to our 2009 review (Eccleston 2009a), the effect sizes for CBT are largely sustained and extended with the addition of catastrophic thinking as an outcome, while those for behaviour therapy are diminished.”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Change in evidence from previous review
What the sources say
- Not checked yetcites Eccleston 2009a
Load-bearingStrength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“It is also comparable with effect sizes of CBT for pain problems in children (Eccleston 2009b) and for major psychological disorders (Butler 2006).”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Summary of results
What the sources say
- Not checked yetcites Eccleston 2009b
- Not checked yetcites Butler 2006 source
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Treatment gains are of the same order as those of other available treatments (Glombiewski 2010), as shown by head-to-head trials of surgery versus psychologically based rehabilitation (Fairbank 2005;Hellum 2011).”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Change in evidence from previous review
What the sources say
- Not checked yetcites Glombiewski 2010
- Not checked yetcites Fairbank 2005 source
- Not checked yetcites Hellum 2011 source
Load-bearingStrength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
In the paper
“The average effects are small, as they are for all treatments of chronic pain (Moore 2010).”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Implications for research
What the sources say
- Not checked yetcites Moore 2010 source
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“Other developments in psychological science have led to new forms of treatments being promoted, and the quality of trials and trial reporting is thought to be improving (Morley 2006).”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > B A C K G R O U N D
What the sources say
- Not checked yetcites Morley 2006 source
Strength:hedged· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“As in the previous review (Eccleston 2009a), we applied a quality rating scale specifically designed for psychological interventions in pain (Yates 2005).”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Assessment of risk of bias in included studies
What the sources say
- Not checked yetcites Yates 2005 source
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Behavioural and cognitive treatments designed to ameliorate pain, distress and disability were first introduced over 40 years ago and are now well established (Fordyce 1968; Keefe Rumble 2004).”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > B A C K G R O U N D
What the sources say
- Not checked yetcites Fordyce 1968 source
- Not checked yetcites Keefe Rumble 2004
Strength:boosted· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The Eccleston 2009a review found 52 trials, of which 40 had data that could be entered into a meta-analysis.”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > B A C K G R O U N D
What the sources say
- Not checked yetcites Eccleston 2009a
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“This analysis is now out of date and in need of updating (Shojania 2007).”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > B A C K G R O U N D
What the sources say
- Not checked yetcites Shojania 2007 source
Load-bearingStrength:plain· not yet calibrated
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passes
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“This last criterion of N > 20 at post-treatment assessment is an improvement from the Eccleston 2009a review in which we used an entry of N > 10.We made this change because of the recognised risk of bias of small numbers (Ioannidis 2005;Nuesch 2009); raising the required N further would be desirable but would exclude too many studies.”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Types of studies
What the sources say
- Not checked yetcites Ioannidis 2005 source
- Not checked yetcites Nuesch 2009 source
Load-bearingStrength:plain· not yet calibratedCausal:direct· not yet calibratedn = 20
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
Probably not a substantial claim.
In the paper
“Compared with doing nothing, behaviour therapy improved pain post-treatment, but showed no other benefits, and there were too few trials of behaviour therapy against active control for analysis.”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > B A C K G R O U N D
What the sources say
- Not checked yetcites Eccleston 2009a
Strength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“Surprisingly, against doing nothing (treatment as usual or waiting list control), there was only significant improvement for pain post-treatment and mood at follow-up.”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > B A C K G R O U N D
What the sources say
- Not checked yetcites Eccleston 2009a
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“Against active control, CBT improved disability post-treatment, and pain, disability and mood at follow-up, although effect sizes were small.”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > B A C K G R O U N D
What the sources say
- Not checked yetcites Eccleston 2009a
Load-bearingStrength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
In the paper
“We assessed risk of bias using the recommended Cochrane guidance (Higgins 2011).”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Assessment of risk of bias in included studies
What the sources say
- Not checked yetcites Higgins 2011
Load-bearingStrength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
Probably not a substantial claim.
In the paper
“Behaviour therapy was developed in the 1960s and 1970s and evaluated as part of the first wave of psychological treatment for pain (Morley 2011).”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > Summary of results
What the sources say
- Not checked yetcites Morley 2011 source
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Although trials do not tend to report adverse effects or deterioration (such as worsening of depression to a level of clinical concern), we know that such effects should be small (Fairbank 2005;Hellum 2011;Morley 2008), so the treatment can be considered to be safe, with the reservation that the reasons for discontinuing treatment are rarely given and may be due to hidden adverse effects.”
§ Psychological therapies for the management of chronic pain (excluding headache) in adults > A U T H O R S ' C O N C L U S I O N S
What the sources say
- Not checked yetcites Fairbank 2005 source
- Not checked yetcites Hellum 2011 source
- Not checked yetcites Morley 2008 source
Load-bearingStrength:hedged· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.

208 of 208

The paper relies on this without support.
Chronic pain is a common problem causing significant distress and disability.
“Chronic pain is a common problem causing significant distress and disability.”
The paper relies on this without support.
The evidence base for psychological therapies is dominated by studies of programmatic and protocolised treatments from a behavioural or cognitive behavioural tradition of clinical psychology.
“The evidence base for psychological therapies is dominated by studies of programmatic and protocolised treatments from a behavioural or cognitive behavioural tradition of clinical psychology.”
The paper relies on this without support.
Patients in waiting list or treatment as usual conditions receive variable and usually unrecorded treatment.
“Thus patients in these conditions receive variable and usually unrecorded treatment.”
The paper relies on this without support.
Catastrophic thinking has emerged as a predictor of behavioural and emotional outcomes in the longer term, and is a widely used target of cognitive treatment.
“This has emerged as a predictor of behavioural and emotional outcomes in the longer term, and is a widely (if not universally) used target of cognitive treatment.”

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Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

Consistentz = 1.43reported p > .05 · recomputed p = .153
“(Z = 1.43,p > .05”
Consistentz = 2.66reported p < .01 · recomputed p = .008
“(Z = 2.66, p < .01”
Consistentz = 0.72reported p > .05 · recomputed p = .472
“(Z = 0.72, p > .05”
Consistentz = 1.92reported p = .05 · recomputed p = .055
“Z = 1.92,p = .05”
Consistentz = 1.12reported p > .05 · recomputed p = .263
“(Z = 1.12,p > .05”
Consistentz = 2.28reported p < .05 · recomputed p = .023
“(Z = 2.28, p < .05”
Consistentz = 1.15reported p > .05 · recomputed p = .250
“(Z = 1.15,p > .05”
Consistentz = 0.49reported p > .05 · recomputed p = .624
“Z = 0.49, p > .05”
Consistentz = 2.59reported p < .05 · recomputed p = .010
“(Z = 2.59, p < .05”
Consistentz = 2.35reported p < .05 · recomputed p = .019
“(Z = 2.35, p < .05”
Consistentz = 3.84reported p < .01 · recomputed p < .001
“(Z = 3.84, p < .01”
Consistentz = 4.58reported p < .01 · recomputed p < .001
“Z = 4.58, p < .01”
Consistentz = 0.99reported p > .05 · recomputed p = .322
“(Z = 0.99, p > .05”
Consistentz = 0.66reported p > .05 · recomputed p = .509
“(Z = 0.66, p > .05”
Consistentz = 1.99reported p = .05 · recomputed p = .047
“(Z = 1.99,p = .05”
Consistentz = 0.84reported p > .05 · recomputed p = .401
“Z = 0.84, p > .05”
Consistentz = 0.77reported p > .05 · recomputed p = .441
“(Z = 0.77, p > .05”
Consistentz = 1.46reported p > .05 · recomputed p = .144
“(Z = 1.46,p > .05”
Consistentz = 1.94reported p = .05 · recomputed p = .052
“(Z = 1.94,p = .05”
Consistentz = 1.67reported p > .05 · recomputed p = .095
“Z = 1.67,p > .05”
Consistentz = 0.13reported p > .05 · recomputed p = .897
“(Z = 0.13, p > .05”
Consistentz = 1.01reported p > .05 · recomputed p = .312
“(Z = 1.01,p > .05”
Consistentz = 1.55reported p > .05 · recomputed p = .121
“(Z = 1.55,p > .05”
Consistentz = 0.25reported p > .05 · recomputed p = .803
“Z = 0.25, p > .05”
Consistentz = 1.05reported p > .05 · recomputed p = .294
“(Z = 1.05,p > .05”
Consistentz = 1.4reported p > .05 · recomputed p = .162
“(Z = 1.40,p > .05”
Consistentz = 1.18reported p > .05 · recomputed p = .238
“(Z = 1.18,p > .05”
Consistentz = 1.99reported p = .05 · recomputed p = .047
“Z = 1.99,p = .05”
Consistentz = 0.21reported p > .05 · recomputed p = .834
“(Z = 0.21, p > .05”
Consistentz = 1.08reported p > .05 · recomputed p = .280
“(Z = 1.08,p > .05”
Consistentz = 0.9reported p > .05 · recomputed p = .368
“(Z = 0.90, p > .05”

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

Catastrophising benefit at follow-up is claimed despite a nonsignificant result
Major
The summary says CBT's benefit for catastrophising versus doing nothing was sustained at follow-up. The follow-up analysis reports only one study and a nonsignificant effect.
Nonsignificant Analysis 4.2 is described as showing an effect
Minor
The heterogeneity discussion groups Analysis 4.2 among four analyses showing an intervention effect, but the results section explicitly calls its overall effect nonsignificant.
Sex counts exceed the stated starting sample in Geraets 2005
Minor
The stated numbers of women and men at the start of treatment total 192, exceeding the stated starting sample of 176.
Reported 176 · recomputed 192
Disability analysis has two different Z statistics
Minor
The narrative reports Z = 1.46 for behavioural therapy versus active control post-treatment, while the corresponding Analysis 5.2 reports Z = 1.56.
Treatment-quality scale has inconsistent denominators
Minor
The methods define the Yates treatment-quality subscale as ranging from 0 to 9, but the Lindell 2008 entry reports its treatment-quality score out of 6.
The post-treatment arm-size threshold is stated two ways
Minor
The inclusion criteria allow 20 participants in each arm, whereas the subsequent description requires more than 20. A study with exactly 20 in an arm would be treated differently under the two rules.

6 of 6

2 retracted

Effect of a Long-lasting Multidisciplinary Program on Disability and Fear-Avoidance Behaviors in Patients With Chronic Low Back Pain: [RETRACTED]: Results of a Randomized Controlled Trial
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Retracted
Retracted: Physical Activity within a CBT Intervention Improves Coping with Pain in Traumatized Refugees: Results of a Randomized Controlled Design
Liedl, A., Müller, J., Morina, N., Karl, A., Denke, C., & Knaevelsrud, C. (2011) · Pain Medicine · doi:10.1111/j.1526-4637.2010.01040.x · Cited by 74
Retracted
Pharmacological interventions for somatoform disorders in adults
Kleinstäuber, M., Witthöft, M., Steffanowski, A., van Marwijk, H., Hiller, W., & Lambert, M. J. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010628.pub2 · Cited by 11,369
Developing and evaluating complex interventions: the new Medical Research Council guidance
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008) · BMJ · doi:10.1136/bmj.a1655 · Cited by 10,995
Why Most Published Research Findings Are False
Ioannidis, J. P. A. (2005) · PLoS Medicine · doi:10.1371/journal.pmed.0020124 · Cited by 10,505
Acceptance and commitment therapy: model, processes and outcomes
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.06.006 · Cited by 6,587
Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration
Higgins, J., Green, S. R., & Higgins, J. (2008) · Cited by 5,544
Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment
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Internet-Delivered Psychological Pain-Management for Young Adults With Chronic Pain: An Investigation of Clinical Trial Data
Dudeney, J., Scott, A. J., Hathway, T., Bisby, M. A., Harte, N., Titov, N., & Dear, B. F. (2024) · The Journal of Pain · doi:10.1016/j.jpain.2023.12.004 · Cited by 9
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Solberg Nes, L., Børøsund, E., Varsi, C., Eide, H., Waxenberg, L. B., Weiss, K. E., Morrison, E. J., Støle, H. S., Kristjansdottir, Ó. B., Bostrøm, K., et al. (2024) · Pain Reports · doi:10.1097/pr9.0000000000001174 · Cited by 7
“72”
Rationale and design of a pilot study examining Acceptance and Commitment Therapy for persistent pain in an integrated primary care clinic
Kanzler, K. E., Robinson, P. J., McGeary, D. D., Mintz, J., Potter, J. S., Muñante, M., Lopez, E. J., Dougherty, D. M., Hale, W. J., & Velligan, D. I. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2018.01.004 · Cited by 7
Baseline Pro-Inflammatory Cytokine Levels Moderate Psychological Inflexibility in Behavioral Treatment for Chronic Pain
Karshikoff, B., Åström, J., Holmström, L., Lekander, M., Kemani, M. K., & Wicksell, R. K. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11092285 · Cited by 6
The Relative Importance of Mindfulness Facets and Their Interactions: Relations to Psychological Symptoms in Chronic Pain
Azizi, Z., Jandaghi, G., Firoozi, M., Zia-Tohidi, A., & Ebnerasouli, S. (2022) · Mindfulness · doi:10.1007/s12671-022-01862-2 · Cited by 6
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Psychological Treatment Targeting Acceptance and Compassion in Patients With Chronic Pain: A Randomized Controlled, Internet-delivered, Treatment Trial
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Bisby, M. A., Chandra, S. S., Scott, A. J., Dudeney, J., Titov, N., & Dear, B. F. (2023) · The Journal of Pain · doi:10.1016/j.jpain.2023.06.004 · Cited by 4
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Casey, M. B., Takemasa, S., O'Reilly, T., Leamy, M., Mc Kearney, E., Buckley, M., Smart, K. M., Segurado, R., Lowry, D., Flanagan, D., et al. (2024) · European Journal of Pain · doi:10.1002/ejp.2229 · Cited by 4
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Joy, D., & Caddle, A. (2023) · British Journal of Pain · doi:10.1177/20494637221135125 · Cited by 2
Functional Rehabilitation: An Integrated Treatment Model for Patients with Complex Physical and Psychiatric Conditions
Orme, W. H., Fowler, J. C., Bradshaw, M. R., Carlson, M., Hadden, J., Daniel, J., Flack, J. N., Freeland, D., Head, J., Marder, K., et al. (2022) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000623 · Cited by 2
Effectiveness of Acceptance and Commitment Therapy for Chronic Pain Patients: A Systematic Review and Meta-Analysis
Kang, H.-S., Hwang, S.-D., & Jun, S.-E. (2019) · Journal of Korean Academy of Psychiatric and Mental Health Nursing · doi:10.12934/jkpmhn.2019.28.3.271 · Cited by 1
Chronische Schmerzen im Alter – psychologische Aspekte und ihre therapeutischen Konsequenzen*
Mattenklodt, P., Ingenhorst, A., Flatau, B., & Grießinger, N. (2024) · Osteologie · doi:10.1055/a-2229-3576
Alternative treatments
Urban, L. A. (2016) · Treating Comorbid Opioid Use Disorder in Chronic Pain · doi:10.1007/978-3-319-29863-4_3

Authors: Williams, A. C. D. C., Eccleston, C., & Morley, S.
Affiliations: University College London (GB)
University of Bath (GB)
University of Leeds (GB)
ORCID: Williams, Amanda C de C
Eccleston, Christopher
Morley, Stephen
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2012-11-14
Volume: 11
Pages: CD007407-CD007407
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd007407.pub3
PMC: PMC6483325
OpenAlex: W1955446149
Semantic Scholar: 8018a1d7b6374a784decc549b0fb6bb0de863f57
Cited by: 1,634
References: 293
Citations by year: 2026: 12 · 2025: 94 · 2024: 126 · 2023: 114 · 2022: 144 · 2021: 160 · 2020: 106 · 2019: 133 · 2018: 111 · 2017: 115 · 2016: 117 · 2015: 104 · 2014: 102 · 2013: 82 · 2012: 40
FWCI: 11.78
Type: journal article
Language: en
Update notices: new_version (2020-08-14)
Open access: bronze
doi.org
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
onlinelibrary.wiley.com/termsAndConditions (vor)
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Funders: American Heart Association
Pfizer
Deutsches Krebsforschungszentrum
National Institute for Health and Care Research
ZonMw
National Institutes of Health (5-R01-)
National Center for Research Resources (-00056)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords: chronic non-cancer pain, psychotherapy, cognitive behavioral therapy, behavior therapy, acceptance and commitment therapy, fibromyalgia, chronic low back pain, rheumatoid arthritis, pain intensity, disability, psychological distress, adverse events, treatment safety, treatment efficacy, adults, risk of bias, quality of evidence, economic burden, health care costs, treatment expectations, selective reporting
MeSH terms: Adult, Affect, Behavior Therapy, Humans, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Chronic Pain

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Psychological therapies for the management of chronic pain (excluding headache) in adults

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