Emotion regulation skills-focused interventions for chronic pain: A systematic review and meta-analysis

IF 3.5 2区医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-04-01 DOI:10.1002/ejp.2268

Nell Norman-Nott, Negin Hesam-Shariati, Michael A. Wewege, Rodrigo R. N. Rizzo, Aidan G. Cashin, Chelsey R. Wilks, Yann Quidé, James H. McAuley, Sylvia M. Gustin

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Abstract

Objectives

To investigate the effect of emotion regulation skills-focused (ERSF) interventions to reduce pain intensity and improve psychological outcomes for people with chronic pain and to narratively report on safety and intervention compliance.

Methods

Six databases and four registries were searched for randomized controlled trials (RCTs) up to 29 April 2022. Risk of bias was evaluated using the Cochrane RoB 2.0 tool, and certainty of evidence was assessed according to the Grading, Assessment, Development and Evaluation (GRADE). Meta-analyses for eight studies (902 participants) assessed pain intensity (primary outcome), emotion regulation, affect, symptoms of depression and anxiety, and pain interference (secondary outcomes), at two time points when available, post-intervention (closest to intervention end) and follow-up (the first measurement after the post-intervention assessment).

Results

Compared to TAU, pain intensity improved post-intervention (weighted mean difference [WMD] = −10.86; 95% confidence interval [CI] [−17.55, −2.56]) and at follow-up (WMD = −11.38; 95% CI [−13.55, −9.21]). Emotion regulation improved post-intervention (standard mean difference [SMD] = 0.57; 95% CI [0.14, 1.01]), and depressive symptoms improved at follow-up (SMD = −0.45; 95% CI [−0.66, −0.24]). Compared to active comparators, anxiety symptoms improved favouring the comparator post-intervention (SMD = 0.10; 95% CI [0.03, 0.18]), and compared to CBT, pain interference improved post-intervention (SMD = −0.37; 95% CI [−0.69, −0.04]). Certainty of evidence ranged from very low to moderate.

Significance

The findings provide evidence that ERSF interventions reduce pain intensity for people with chronic pain compared to usual treatment. These interventions are at least as beneficial to reduce pain intensity as the current gold standard psychological intervention, CBT. However, the limited number of studies and certainty of evidence mean further high-quality RCTs are warranted. Additionally, further research is needed to identify whether ERSF interventions may be more beneficial for specific chronic pain conditions.

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以情绪调节技能为重点的慢性疼痛干预：系统回顾和荟萃分析。

目的调查以情绪调节技能为重点的干预（ERSF）对降低慢性疼痛患者的疼痛强度和改善其心理结果的效果，并对安全性和干预依从性进行叙述性报告：方法：检索了六个数据库和四个登记处，以查找截至 2022 年 4 月 29 日的随机对照试验 (RCT)。使用 Cochrane RoB 2.0 工具评估了偏倚风险，并根据分级、评估、发展和评价 (GRADE) 评估了证据的确定性。8项研究（902名参与者）的元分析评估了疼痛强度（主要结果）、情绪调节、情感、抑郁和焦虑症状以及疼痛干扰（次要结果），评估的两个时间点为干预后（最接近干预结束）和随访（干预后评估后的首次测量）：与TAU相比，疼痛强度在干预后（加权平均差[WMD] = -10.86；95%置信区间[CI] [-17.55, -2.56]）和随访时（WMD = -11.38；95%置信区间[-13.55, -9.21]）有所改善。干预后，情绪调节能力有所改善（标准平均差 [SMD] = 0.57；95% CI [0.14，1.01]），随访时抑郁症状有所改善（SMD = -0.45；95% CI [-0.66，-0.24]）。与积极的比较者相比，干预后比较者的焦虑症状有所改善（SMD = 0.10；95% CI [0.03，0.18]），与 CBT 相比，干预后疼痛干扰有所改善（SMD = -0.37；95% CI [-0.69，-0.04]）。证据的确定性从很低到中等不等：研究结果证明，与常规治疗相比，ERSF干预能降低慢性疼痛患者的疼痛强度。这些干预措施在降低疼痛强度方面至少与目前的金标准心理干预措施（CBT）一样有益。然而，由于研究数量有限且证据的确定性较低，因此需要进一步开展高质量的 RCT 研究。此外，还需要进一步研究，以确定 ERSF 干预是否对特定的慢性疼痛状况更有益。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.