Devine, E.C. (2003). Meta-analysis of the effect of psychoeducational interventions on pain in adults with cancer. Oncology Nursing Forum, 30(1), 75–89.

To obtain estimates of the effect of selected psychoeducational interventions on pain in patients with cancer

• Databases searched were PubMed, CINAHL, Dissertation Abstracts, PsycLIT, and the Cochrane Database of Systematic Reviews.
• Keywords searched were cancer, neoplasms, patient education, counseling, behavioral therapy, guided imagery, hypnosis, relaxation therapy, music, and pain.
• Studies were included if they
  • Were experimental, quasi-experimental, or employed a pre/post-test single-group design.
  • Included outcome measurement for which an effect size could be calculated.
• Studies were excluded if they compared psychoeducational therapy to pharmacologic treatment for pain, involved fewer than five subjects in each treatment condition, and included treatment and control groups from different settings.

The search retrieved 50 studies. Authors eliminated 25 studies on the basis of inclusion and exclusion criteria. Authors did not describe the method of evaluation.

• Across all studies, the sample included 1,354 patients with various types of cancer. The sample range was 7–206 patients.
• Authors included 25 studies in meta-analysis. 

• Types of interventions: Interventions included listening to music, hypnosis, progressive muscle relaxation and imagery, cognitive-behavioral counseling, distraction, and support groups.
• Effects on pain:
  • Relaxation, guided imagery music, or hypnosis interventions: Twelve studies used an intervention of this type, demonstrating an average weighted effect size of 0.65 (p < 0.05).
  • Education interventions: Six studies included this type of intervention.  Overall average effect size was 0.36 (p < 0.05).
  • Support plus other content: Five studies were included in this group.  Average effect size was 0.44 (p < 0.05).
  • Relaxation plus other content: Six studies showed an effect size of 0.07.

Most studies demonstrated that psychoeducational interventions had at least a small positive effect on pain in patients with cancer.

• This analysis included a broad variety of interventions, a fact that raises questions about the generalizability of conclusions from the analysis.
• Authors identified a number of methodologic and reporting issues, which raises concerns about the validity and utility of study findings.
• Several studies had very small sample sizes and reported very high attrition rates.
• Differences among educational interventions, cognitive behavioral therapy interventions, and usual care are unclear.
• Most of the education studied in this research was aimed at enhancing patient use of prescribed analgesic regimens.

Further well-designed research in this area is needed. The complexity of cancer-related pain presents a number of challenges inherent in this research; authors outline these challenges. Psychoeducational interventions may be more acceptable to some patients than others, as high attrition rates suggest. In addition, rating pain is a subjective activity. The efficacy of an intervention may differ with cancer phase and with different pain severity. These factors should affect selection of intervention type.