Sheinfeld Gorin, S., Krebs, P., Badr, H., Janke, E.A., Jim, H.S., Spring, B., . . . Jacobsen, P.B. (2012). Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 30(5), 539–547.

• To perform a meta-analysis to obtain a current, comprehensive, and robust estimate of the effect of psychosocial interventions on cancer-related pain
• To determine  whether the effects of psychosocial interventions on pain in patients with cancer differ by intervention type (skills- versus education-based approach)
• To explore, in the study context, the relationship between intervention design and patient sociodemographics

• Databases searched were MEDLINE, PsycINFO, CINAHL, EMBASE, and the Cochrane Library.
• Search terms indicating pain (e.g., pain, nociceptors) and presence of cancer (e.g., neoplasm, cancer, leukemia) were combined with terms relating to psychosocial interventions (e.g., psychotherapy, hypno$, desensitis$, meditate$) and publication types (e.g., randomized controlled trial, controlled clinical trial).
• Studies were included if they
  • Were published in English on a date that fell in a period after the earliest date available in each database and before 2011.
  • Included adult subjects (those 18 years old or older) with a diagnosis of cancer or who were undergoing procedures for diagnosis of cancer.
  • Employed random assignment.
  • Assessed pain.
  • Included a usual-care or no-treatment control condition.
  • Employed a psychosocial intervention—that is, any approach involving cognitive behavioral techniques, stress management, relaxation training, education, hypnosis, or other experiential techniques. (Interventions could be provided in any of multiple formats, including individual, group, couples, telephone, or Internet-based modality.)
• Studies were excluded if they used alternative therapies as the primary treatment, as is the case with massage and Reiki therapy.
   

The search retrieved 1,681 studies published 1996–2010. Three pairs of raters independently reviewed 1,681 abstracts, using an online coding program designed for this project. Studies meeting the inclusion criteria were evaluated for quality according to a modified seven-item coding scheme based on the Physiotherapy Evidence Database. The project leader reviewed findings from rater pairs, resolved discrepancies, and produced a final list of studies for full-text examination. The list of studies was divided among the three pairs of raters.
 

• The number of studies that met inclusion criteria was 42; 37 provided sufficient data for meta-analysis.
• The total sample was composed of 4,199 patients.
• Authors did not report the sample range.
• Of all patients, 66% were women. The sample was primarily white (72%). Most of the studies (65%) included cancer at various stages at baseline. At baseline, 54% of the sample was receiving chemotherapy. Of all patients, 71% were receiving outpatient care.

The weighted average effect size in 38 comparisons for pain severity (k = 38) was 0.34 (95% CI 0.23–0.46; p < 0.001). The weighted average effect size in four comparisons for pain interference was 0.40 (95% CI 0.21–0.60; p < 0.001). Among studies that measured pain severity, skills-based interventions yielded a higher but statistically nonsignificant effect size than did educational approaches (k = 18, g = 0.45 versus k = 19, g = –0.29, respectively; p = 0.22).

Psychosocial interventions decrease cancer-related pain severity and the extent to which pain interferes with activities. Both skills instruction and education approaches can improve the management of cancer pain.