Systematic Review of the Comparative Effectiveness of Cognitive-Behavioural Therapies for Chronic Pain

Abstract

Despite the shown effectiveness of Cognitive-Behavioural Therapies (CBT) for chronic pain, it is not clear which CBT approach is more effective and which components or combinations of CBT account for a better treatment outcome. In this regard, this study aimed to systematically review the studies investigating the effectiveness of all forms of CBT for the treatment of individuals with chronic pain. For this purpose, randomised controlled clinical trials on adults with chronic pain published between the years of 2006 and 2016 have been searched in the Google Scholar, Web of Science and EBSCO databases by using the keywords “chronic pain”, “pain disorders”, “cognitive behavioural therapy” or “treatment”. Following database search, 24 trials were identified based on the eligibility criteria. Primary outcomes were demonstrated to be pain intensity, disability, self-efficacy, and pain control, whereas secondary outcomes were related to emotional difficulties. In terms of comparative effectiveness, findings revealed that all forms of CBT are significantly more effective than physical treatments, particularly for emotional problems. However, no statistically significant differences were found for the comparison of traditional CBT and mindfulness and acceptance-based treatments. Findings further underlined that some forms of CBT appeared to produce greater improvements in some of the outcome measures. Findings of this review emphasise that what is in fact responsible for the positive outcome while delivering CBT for chronic pain is still not clear. Thus, future research should focus on identifying specific components and underlying mechanisms of CBT in order to maximize treatment outcome.