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Cited by 123Musculoskeletal pain and rehabilitationPain Management and TreatmentPediatric Pain Management Techniques

Examining the evidence about psychological treatments for chronic pain: Time for a paradigm shift?

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Morley, Stephen, Williams, Amanda, Eccleston, Christopher·2013·Pain
DOI 10.1016/j.pain.2013.05.049
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Abstract

Psychological interventions are now well established as a core part of modern pain practice. Randomized controlled trials (RCT) of psychological treatment for chronic pain were first performed in the 1970s, and considerable effort, skill, and sophistication have been applied to establishing the evidence of effectiveness [26]. Over the last 2 decades, we and others have conducted systematic reviews and meta-analyses of psychological interventions, predominantly cognitive behaviour therapy (CBT), for chronic pain [3,6,8,16,17,27,40]. Meta-analysis facilitates the emergence of underlying patterns in data by controlling the bias and error inherent in individual studies. These meta-analyses suggest that, overall, CBT has a beneficial average effect for a range of outcomes, principally disability, depression, and pain experience. Evidence of harm is not available. Although the headline effect is positive, current analyses are limited to average results, and conclusions are typically confined to the general. The aim of this topical review is to consider the next steps in developing and evaluating psychological treatments for chronic pain. In this examination, we take as our unit of analysis the meta-analyses rather than individual RCTs. We briefly summarize the results of the meta-analyses, their benefits, and their limits, then offer directions for improving the next generation of studies. We argue that we have reached a critical point in the evolution of psychological interventions, and a paradigm shift is now needed in how we investigate treatment efficacy, effectiveness, and harm.

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  • Mostly small to moderate effect sizes on disability, mood, catastrophizing, and pain have been reported for CBT; long-term effects are unclear; and the diversity of CBT interventions has made it hard to identify treatment mechanisms.

    “Mostly small to moderate effect sizes on disability, mood, catastrophizing and pain have been reported, longterm effects are unclear, and the diversity of CBT interventions has made it hard to identify treatment mechanisms (Eccleston et al., 2009;Morley et al., 2013;Williams et al., 2012).”

    From Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up (2021) · cites this paper as Morley et al., 2013

    The supplied passages contain bibliographic information but no discussion of CBT outcomes. Searches of our copy for effect sizes, catastrophizing, long-term effects, and treatment mechanisms returned no relevant passage, so the claim cannot be checked against it. (LLM, conf=0.76)

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Authors
Morley, S., Williams, A., & Eccleston, C.
Affiliations
  • University of Leeds (GB)
  • University College London (GB)
  • University of Bath (GB)
Corresponding author
Morley, Stephen
ORCID
Venue
Pain
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-10
Volume
154
Issue
10
Pages
1929-1931
ISSN
0304-3959 (ISSN-L)
DOI
10.1016/j.pain.2013.05.049
OpenAlex
W2039052983
Cited by
123
References
13
Citations by year
2026: 3 · 2025: 5 · 2024: 2 · 2023: 6 · 2022: 7 · 2021: 12 · 2020: 9 · 2019: 10 · 2018: 12 · 2017: 19 · 2016: 10 · 2015: 11 · 2014: 14 · 2013: 3
FWCI
9.28
Type
journal article
Language
en
Open access
Licence
Locations
  • Pain (publishedVersion)
  • PubMed (publishedVersion)
  • The University of Bath Online Publications Store (The University of Bath) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Pure (University of Bath) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords
chronic pain, psychological intervention, cognitive behavioral therapy, meta-analysis, treatment efficacy, treatment harms, disability, depression, pain experience, randomized controlled trials, paradigm shift
MeSH terms
Humans, Psychotherapy, Time Factors, Randomized Controlled Trials as Topic, Treatment Outcome, Chronic Pain, Pain Management

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