Meta-Analysis of Psychosocial Interventions to Reduce Pain in Patients With Cancer
Open accessAbstract
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.
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Existing behavioral symptom management interventions for cancer survivors have been primarily developed and tested among older cancer survivors aged over 40.
“Existing behavioral symptom management interventions for cancer survivors have been primarily developed and tested among older cancer survivors (aged > 40) [27–32].”
From Improving symptom management for survivors of young adult cancer: rationale and study protocol for a pilot randomized controlled trial (2024) · cites this paper as [31]
Cancer affects quality of life from diagnosis, progression, adverse effects of treatment and diagnostic procedures by affecting physical, physiological and emotional problems of patients.
“Cancer affects the quality of life from its starting stage of diagnosis, progression, adverse effects of its treatment and diagnostic procedures by affecting the physical, physiological and emotional problems of patients [48-56] .”
From Alternative Medicine: New Ways to Treat Diseases and Therapies (2021) · cites this paper as [55]
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Pain Management for Patients With Advanced Cancer in the Opioid Epidemic Era
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“These provided evidence of a small effect of psychosocial interventions and preliminary evidence of the effectiveness of acupuncture [29], while indicating that education-based interventions are not effective [30,31].”
BackgroundThe effects of spiritual interventions in patients with cancer: a meta-analysis.
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“%) in point estimate that can be attributed to systematic differences between studies; a larger percentage reflects greater heterogeneity (Sheinfeld Gorin et al., 2012).”
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The biopsychosocial model in cancer pain
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SEOM clinical guideline for treatment of cancer pain (2017)
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Complementary therapies for symptom management in cancer patients
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“Sheinfeld Gorin et al.[39] Meta-analysis (37 studies) Cancer Psycho-social interventions (including hypnosis) have medium size effect on pain severity and interference”
BackgroundSingle-cell RNA sequencing uncovers a neuron-like macrophage subset associated with cancer pain
Tang, P. C., Chung, J. Y., Liao, J., Chan, M. K., Chan, A. S. W., Cheng, G., Li, C., Huang, X., Ng, C. S. H., Lam, E. W. ‐., et al. (2022) · Science Advances · doi:10.1126/sciadv.abn5535 · Cited by 76 · see citing works
“This is especially pertinent in patients with advanced cancers of the lung, breast, prostate, or gastrointestinal tract, as two-thirds of these patients suffer from chronic pain ( 2 , 3 ).”
Caring for the Whole Patient: The Science of Psychosocial Care
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“In the reviewed studies, the sample sizes were small (9-150), and the number of studies in general was limited.”
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Management of pain in colorectal cancer patients
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Presentation and management of chronic pain
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Neuropathic cancer pain: What we are dealing with? How to manage it?
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“Cognitive–behavioral interventions and mind–body therapies (relaxation, imagery, hypnosis, and biofeedback) may have a role to play.(173) It is hypothesized that the mechanism of NCP intersects with the pain-relieving mechanism of acupuncture.”
Treating persistent pain after breast cancer surgery
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Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis
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“Psychoeducational interventions such as cognitive behavioral therapy (CBT) are specifically aimed at helping patients to take control of their pain experience, and interventions of this kind were found to be especially efficacious in a previous meta-analysis [13].”
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The 2014–2018 Oncology Nursing Society Research Agenda
Knobf, M. T., Cooley, M. E., Duffy, S. A., Doorenbos, A. Z., Eaton, L. H., Given, B. A., Mayer, D. K., McCorkle, R. C., Miaskowski, C. A., Mitchell, S. A., et al. (2015) · Oncology nursing forum · doi:10.1188/15.onf.450-465 · Cited by 55 · see citing works
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Yennurajalingam, S., Kang, D.-H., Hwu, W., Padhye, N. S., Masino, C., Dibaj, S. S., Liu, D. D., Williams, J. L., Lu, Z., & Bruera, E. D. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.08.027 · Cited by 51 · see citing works
“ranges (milligrams) were: carbidopa/levodopa (30/300), alprazolam (1), amitriptyline (10), citalopram (20-40), duloxetine (30-60), eszopiclone (3), fluoxetine (20), mirtazapine (7.”
BackgroundAn Overview of Systematic Reviews: Complementary Therapies for Cancer Patients
Lee, S. M., Choi, H. C., & Hyun, M. K. (2019) · Integrative Cancer Therapies · doi:10.1177/1534735419890029 · Cited by 49 · see citing works
Poletti, S., Razzini, G., Ferrari, R., Ricchieri, M. P., Spedicato, G. A., Pasqualini, A., Buzzega, C., Artioli, F., Petropulacos, K., Luppi, M., et al. (2019) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2019.102218 · Cited by 48 · see citing works
Mechanism-based cancer-pain therapy
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Psychosocial interventions for cancer survivors: a meta-analysis of effects on positive affect
Salsman, J. M., Pustejovsky, J. E., Schueller, S. M., Hernandez, R., Berendsen, M., McLouth, L. E. S., & Moskowitz, J. T. (2019) · Journal of Cancer Survivorship · doi:10.1007/s11764-019-00811-8 · Cited by 45 · see citing works
Self-citationMultidimensional Treatment of Cancer Pain
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Disease burden and pain in obese cancer patients with chemotherapy-induced peripheral neuropathy
Cox-Martin, E., Trahan, L. H., Cox, M. G., Dougherty, P. M., Lai, E. A., & Novy, D. M. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3571-5 · Cited by 40 · see citing works
“tive behavioral therapies have also been successful in targeting a range of issues pertinent to cancer survivorship [39, 40], including weight management [40], pain [41, 42],”
Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis
McElfresh, J. J., Skiba, M. B., Segrin, C. G., Badger, T. A., Crane, T. E., Crist, J. D., & Thomson, C. A. (2021) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2020.1867690 · Cited by 38 · see citing works
Psychological Symptoms in Advanced Cancer
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Plumb Vilardaga, J. C., Winger, J. G., Teo, I., Owen, L., Sutton, L. M., Keefe, F. J., & Somers, T. J. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2019.09.005 · Cited by 36 · see citing works
Meta-analysis of psychosocial interventions on survival time in patients with cancer
Oh, P. J., Shin, S. R., Ahn, H. S., & Kim, H. (2015) · Psychology and Health · doi:10.1080/08870446.2015.1111370 · Cited by 35 · see citing works
“, 2012) and increase well-being of cancer patients (Faller et al., 2013; Newell, Sanson-Fisher, & Savolainen, 2002; Oh & Lee, 2013; Osborn et al., 2006; Gorin et al., 2012), its effectiveness in prolonging survival when added to a standard regimen remains controversial.”
BackgroundMethodInfluentialRini, C. K., Porter, L. S., Somers, T. J., McKee, D. C., & Keefe, F. J. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3374 · Cited by 35 · see citing works
“For example, studies of behavioral approaches to treating persistent musculoskeletal pain, cancer pain, and other types of persistent pain are yielding growing evidence for the efficacy of interventions based on cognitive behavioral therapies (CBT; eg, [9,11-13])—the most commonly researched and used psychotherapeutic…”
Azizoddin, D. R., Schreiber, K. L., Beck, M. R., Enzinger, A. C., Hruschak, V., Darnall, B. D., Edwards, R. R., Allsop, M. J., Tulsky, J. A., Boyer, E. W., et al. (2021) · Cancer · doi:10.1002/cncr.33645 · Cited by 35 · see citing works
Morres, I. D., Tzouma, N.-A., Hatzigeorgiadis, A., Κrommidas, C., Kotronis, K. V., Dafopoulos, K. C., Theodorakis, Y., & Comoutos, N. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.124 · Cited by 33 · see citing works
Eaton, L. H., Brant, J. M., McLeod, K., & Yeh, C. H. (2017) · Clinical journal of oncology nursing · doi:10.1188/17.cjon.s3.54-70 · Cited by 33 · see citing works
“Rustoen et al., 2012 Home visits and telephone interviews 179 patients with metastatic bone pain; RCT Statistically significant improvement in pain – Rustoen et al., 2014 Home visits and telephone interviews 147 patients with metastatic bone pain; RCT No difference between groups No blinding; attrition was less than 1…”
InfluentialAigner, C. J., Cinciripini, P. M., Anderson, K. O., Baum, G. P., Gritz, E. R., & Lam, C. Y. (2015) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntv118 · Cited by 32 · see citing works
Survivorship: Pain Version 1.2014
Denlinger, C. S., Ligibel, J. A., Are, M., Baker, K. S., Demark‐Wahnefried, W., Friedman, D. L., Goldman, M. E., Jones, L. W., King, A. A., Ku, G., et al. (2014) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2014.0054 · Cited by 30 · see citing works
Cancer in Other Words? The Role of Metaphor in Emotion Disclosure in Cancer Patients
Lanceley, A., & Clark, J. M. (2013) · British Journal of Psychotherapy · doi:10.1111/bjp.12023 · Cited by 29 · see citing works
“A major portion of this work was done at UCLH/UCL within the ‘women’s health theme’ of the NIHR UCLH/UCL Comprehensive Biomedical Research Centre supported by the Department of Health.”
BackgroundMethodPain and quality of life in T urkish cancer patients
Ovayolu, N., Ovayolu, Ö., Serçe, S., Tuna, D., Çöçelli, L. P., & Sevinç, A. (2013) · Nursing and Health Sciences · doi:10.1111/nhs.12047 · Cited by 29 · see citing works
Using Relaxation and Guided Imagery to Address Pain, Fatigue, and Sleep Disturbances: A Pilot Study
Nooner, A., Dwyer, K. A., DeShea, L., & Yeo, T. P. (2016) · Clinical journal of oncology nursing · doi:10.1188/16.cjon.547-552 · Cited by 29 · see citing works
“Pain prevalence in patients with cancer is estimated to be as high as 53%–60% (Gorin et al., 2012; Montague & Green, 2009).”
BackgroundWilson, J. M., Schreiber, K. L., Mackey, S., Flowers, K. M., Darnall, B. D., Edwards, R. R., & Azizoddin, D. R. (2022) · Psycho-Oncology · doi:10.1002/pon.6020 · Cited by 28 · see citing works
“, depression) predating one's cancer experience, or symptoms following diagnosis and treatment, have also shown to contribute to cancer‐related pain.(3,4) If left undertreated, cancer‐related pain can become chronic and has shown to negatively affect adherence to cancer treatments and quality of life, and even a desir…”
BackgroundInfluentialCancer-related pain management in clinical oncology
Cipta, A. M., Pietras, C. J., Weiss, T. E., & Strouse, T. B. (2015) · The Journal of Community and Supportive Oncology · doi:10.12788/jcso.0173 · Cited by 28 · see citing works
“Conversely, psychosocial stress can exacerbate physical pain, as was elucidated by a meta-analysis of randomized controlled studies on adult cancer patients during 1966-2010 that found positive efects of psychosocial interventions on pain severity.(13) Similarly, spiritual interventions can be important for some patie…”
BackgroundAzizoddin, D. R., DeForge, S. M., Baltazar, A. R., Edwards, R. R., Allsop, M. J., Tulsky, J. A., Businelle, M. S., Schreiber, K. L., & Enzinger, A. C. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08307-7 · Cited by 28 · see citing works
Meta-analysis of Psychosocial Interventions to Reduce Pain in Patients with Cancer
Oh, P. J., & Han, S. J. (2013) · Journal of Korean Academy of Nursing · doi:10.4040/jkan.2013.43.5.658 · Cited by 27 · see citing works
“인지행동중재는 왜곡된 인지, 정서 및 행동을 변화시키거 나 문제해결을 위한 대처기술을 학습하는데 초점을 둔 체계적인 심 리적 접근으로 암환자가 통증을 해석하는 방식을 변화시키고 통증 조절을 위한 근육이완요법 등의 기술을 학습시키는(Gorin et al., 2012) 심리사회적 중재에서 가장 흔히 적용되는 접근법이다.”
InfluentialInterventions to support self-management in cancer pain
ElMokhallalati, Y., Mulvey, M. R., & Bennett, M. (2018) · PAIN Reports · doi:10.1097/pr9.0000000000000690 · Cited by 26 · see citing works
“However, 2 other meta-analyses suggested that effect size was independent of dose.(7,18) Until recently, standardised approaches to delivery of self-”
BackgroundWinger, J. G., Ramos, K., Steinhauser, K. E., Somers, T. J., Porter, L. S., Kamal, A. H., BREITBART, W. S., & Keefe, F. J. (2020) · Palliative & Supportive Care · doi:10.1017/s1478951520000115 · Cited by 26 · see citing works
Winger, J. G., Kelleher, S. A., Ramos, K., Check, D. K., Yu, J. A., Powell, V. D., Lerebours, R. C., Olsen, M. K., Keefe, F. J., Steinhauser, K. E., et al. (2023) · Psycho-Oncology · doi:10.1002/pon.6151 · Cited by 26 · see citing works
Johannsen, M., Sørensen, J. R., O’Connor, M., Jensen, A. B., & Zachariae, R. H. (2017) · Psycho-Oncology · doi:10.1002/pon.4450 · Cited by 25 · see citing works
Handberg, C., Thorne, S. E., & Maribo, T. (2018) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2018.01.010 · Cited by 25 · see citing works
Cancer Pain Management: What’s New?
Gaertner, J., & Schießl, C. (2013) · Current Pain and Headache Reports · doi:10.1007/s11916-013-0328-9 · Cited by 24 · see citing works
Symptom Management and Palliative Care in Pancreatic Cancer
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Ben-Arye, E., Paller, C. J., Lopez, A. M., White, S., Pendleton, E., Kienle, G. S., Samuels, N., Abbawaajii, N., & Balneaves, L. G. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06205-w · Cited by 34 · see citing works
“In recent years, integrative oncology clinical practice has been supported by evidence arising from high-quality randomized controlled trials that indicate many integrative oncology modalities are both effective and safe for the management of issues that impinge on patients’ quality of life (QoL), such as cancer-relat…”
BackgroundDeng, G. E., Giralt, S., Chung, D. J., Landau, H. J., Siman, J., Li, Q. S., Lapen, K., & Mao, J. J. J. (2019) · Pain Medicine · doi:10.1093/pm/pnz190 · Cited by 24 · see citing works
“A recent metaanalysis of 122 studies (N1⁄4 4,199) showed that about 55% of patients experience pain during cancer treatment, with 40% experiencing pain after curative treatment [1].”
BackgroundRaphaelis, S., Frommlet, F., Mayer, H., & Koller, A. (2020) · BMC Cancer · doi:10.1186/s12885-020-06729-0 · Cited by 24 · see citing works
Winger, J. G., Ramos, K., Kelleher, S. A., Somers, T. J., Steinhauser, K. E., Porter, L. S., Kamal, A. H., BREITBART, W. S., & Keefe, F. J. (2021) · Journal of Palliative Medicine · doi:10.1089/jpm.2021.0081 · Cited by 22 · see citing works
“Pain Coping Skills Training can reduce cancer pain, 29,32 but it does not address existential concerns that are common in patients with life-threatening illness.”
Psychosocial intervention in palliative care: What do psychologists need to know
Feldstain, A. (2024) · Journal of Health Psychology · doi:10.1177/13591053231222848 · Cited by 22 · see citing works
Phimphasone-Brady, P., Palmer, B., Vela, A., Johnson, R. L., Harnke, B., Hoffecker, L., Coons, H. L., & Epperson, C. N. (2022) · F&S Reviews · doi:10.1016/j.xfnr.2021.11.004 · Cited by 20 · see citing works
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“…of systematic reviews and meta-analyses of randomized controlled trials of interventions incorporating SM techniques show that they are effective in improving quality of life and relieving emotional distress in cancer patients undergoing treatment (e.g. Gorin et al., 2012; Jacobsen & Jim, 2008).”
BackgroundSelf-citationSomers, T. J., Winger, J. G., Fisher, H. M., Hyland, K. A., Davidian, M., Laber, E. B., Miller, S. N., Kelleher, S. A., Vilardaga, J. P., Majestic, C. M., et al. (2023) · Pain · doi:10.1097/j.pain.0000000000002915 · Cited by 22 · see citing works
Effectiveness of mental health interventions for older adults in South Asia: A scoping review
Mazumder, H., Faizah, F., Gain, E. P., Eva, I. S., Mou, K. F., Saha, N., Rahman, F., Das, J., Islam, A. M. K., Nesa, F., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0287883 · Cited by 26 · see citing works
Steel, J. L., George, C. J., Terhorst, L. A., Yabes, J. G., Reyes, V. E., Zandberg, D. P., Nilsen, M. L., Kiefer, G. J., Johnson, J. T., Marsh, C., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)00015-1 · Cited by 21 · see citing works
- Authors
- Sheinfeld Gorin, S., Krebs, P., Badr, H., Janke, E. A., Jim, H. S. L., Spring, B., Mohr, D. C., Berendsen, M. A., & Jacobsen, P. B.
- Affiliations
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago,...
- University of the Sciences (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2012-02-10
- Volume
- 30
- Issue
- 5
- Pages
- 539-547
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC6815997
- OpenAlex
- W2130414707
- Cited by
- 292
- References
- 65
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 22 · 2023: 20 · 2022: 26 · 2021: 30 · 2020: 23 · 2019: 24 · 2018: 28 · 2017: 24 · 2016: 16 · 2015: 18 · 2014: 19 · 2013: 13 · 2012: 8
- FWCI
- 4.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (RC1DK087126)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- cancer pain, psychosocial interventions, pain intensity, pain interference, pain management, multimodal pain management, intervention fidelity, quality of evidence
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Biofeedback, Psychology, Female, Humans, Hypnosis, Male, Middle Aged, Neoplasms, Pain, Pain Measurement, Patient Education as Topic, Relaxation Therapy, Severity of Illness Index, Social Support, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Pain Management
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Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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