ABSTRACT
BACKGROUND: In cancer patients, pain is one of the main symptoms and especially in the late stages of disease, these symptoms can be associated with considerable suffering. In psycho-oncology, preliminary psychological therapies targeting cancer pain have been tested; however, a systematic review of available interventions is lacking, especially considering their dissemination, evidence base, study quality, and the comparison with established treatments. Therefore, the aim of the current study is to systematically review the current research on psychological treatments for pain in cancer patients. MATERIALS AND METHODS: During May 2014, MEDLINE, PsycINFO, PSYNDEX, and CENTRAL databases were searched. Psychological treatments for pain in adult cancer patients studied in randomized, controlled trials (RCTs) and referring to pain as primary or secondary outcome were included. After examination for inclusion, structured data extraction and assessment followed. Data were synthesized narratively. RESULTS: In the review, 32 RCTs were included. Studies mainly referred to patients with breast cancer or patients in earlier stages of the disease. The methodological quality of included studies was heterogeneous. Most commonly, short interventions were delivered by nurses in out-patient settings. Interventions including education and relaxation techniques were utilized most often, followed by interventions with behavioral or cognitive components. CONCLUSION: A need for research persists regarding efficacy of current psychotherapeutic interventions, or the role of mediator variables (e. g., coping) on pain perception in cancer patients. Studies with high methodological quality which comprehensively and transparently report on interventions and designs are lacking.
Subject(s)
Cancer Pain/psychology , Cancer Pain/therapy , Patient Education as Topic , Relaxation Therapy , Adult , Ambulatory Care , Behavior Therapy , Breast Neoplasms/nursing , Breast Neoplasms/pathology , Breast Neoplasms/psychology , Breast Neoplasms/therapy , Cognitive Behavioral Therapy , Combined Modality Therapy , Female , Humans , Neoplasm Staging , Randomized Controlled Trials as TopicABSTRACT
INTRODUCTION: The efficacy of functional restoration programs for the treatment of chronic back pain is well documented. Nevertheless, there are only a few such centres in Germany and few trials have been conducted in German-speaking regions to demonstrate that implementing such programs in everyday clinical settings with large numbers of patients is just as effective as in a research setting. The present study examined whether the positive effects of such programs can also be observed in the clinically relevant context of a standardized day clinic treatment regimen. MATERIAL AND METHODS: A total of 681 back pain patients in 2 German cities were examined at 4 measurement points (before and immediately after the program, as well as 6 and 12 months after treatment) using a comprehensive questionnaire on perceived pain and symptoms of anxiety and depression, as well as the work situation. RESULTS: In both cities significant and long-term improvements in back pain, pain-related impairment and degree of chronification were observed, as well as a high return-to-work rate after treatment. Hence, the quality of such programs was also confirmed for a large patient population.
Subject(s)
Back Pain/rehabilitation , Cognitive Behavioral Therapy/methods , Cooperative Behavior , Day Care, Medical , Health Services Research , Interdisciplinary Communication , Adult , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Combined Modality Therapy/methods , Comorbidity , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Disability Evaluation , Female , Follow-Up Studies , Germany , Hospitals, University , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Prospective Studies , Quality of Life/psychology , Surveys and QuestionnairesABSTRACT
INTRODUCTION: The empirical findings on risk factors for a favorable/unfavorable outcome upraised via pain intensity, disability and functional capacity after empirically well-evaluated multimodal treatment are inconsistent. The objective of this study was to analyze the relevance of psychosocial and pain-related variables for therapeutic outcome in an unselected sample of patients with chronic non-specific back pain (CBP). METHODS: Included were 681 patients with CBP referred to an outpatient-based multidisciplinary pain rehabilitation program and 320 took part in a survey 12 months later. Before, directly after and 12 months after the program the patients received a questionnaire which contained pain-related items on pain intensity, disability, self-reported functional capacity which were defined as outcome variables, psychological items (anxiety, depression) and work-related items which represented probable predictor variables. Multivariable regression analyses were calculated to estimate the contribution of the selected parameters on pain intensity, disability and functional capacity. RESULTS: The calculated regressions showed only a moderate ability to predict or explain the outcomes pain intensity, disability and functional capacity. However, depression and body mass index (BMI) were significantly related to pain-related therapeutic outcome.
