Psychological interventions for patients with chronic pain. Individual compared to group treatment

Chronic pain is common and can lead to great suffering for those affected. Pain conditions are also the reason for a lot of the sick leave in Sweden. Psychological interventions such as CBT and ACT are commonly used methods to treat chronic pain.

Reading time approx. 5 minutes Published: July 5, 2021 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: July 5, 2021 Report no: ut202118 Registration no: SBU 2021/173

Question

What scientific studies are there on the effect of psychological interventions with CBT or ACT, delivered either as individual or in group, to persons with chronic pain?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
G-CBT = Group-based cognitive behavioral therapy; I-CBT = Individual cognitive behavioral therapy; SMD = Standardized mean difference
Included studies	Population/Intervention	Outcome
Niknejad et al, 2018, [1]
Study designs: Included only randomized controlled trials n=22 studies with a total of 2608 participants. Risk of bias: Used Yates quality scores, where a score of 22.7 is deemed as excellent quality. The mean quality scores in the included studies were 24.5.	Population: Elderly (Mean age >60 years) with chronic (>3 mon) non-cancerous pain. Intervention: Evaluation of a CBT technique. For example, behavioural and cognitive coping skills, cognitive restructuring, behavioural activation, and acceptance. Control: Different in the different studies including waiting list, exercise, education, usual care	Pain intensity at short follow-up (SMD): G-CBT compared to control: –0.202 (p=0.08) I-CBT compared to control: –0.120 (p=0.38) Because of lack of documented results, no more outcomes connected to individual vs group treatment could be presented.
Authors' conclusion: “The observed benefits were strongest when delivered using group-based approaches. Potential mechanisms that could account for this finding include access to peer support, social facilitation of target behaviours, and public commitment to therapy goals.”

References

Niknejad B, Bolier R, Henderson CR, Delgado D, Kozlov E, Löckenhoff CE, et al. Association between psychological interventions and chronic pain outcomes in older adults: A systematic review and meta-analysis. JAMA Intern Med 2018;178:830-839.

Literature search

Embase via embase.com 2021-05-19

Psychological treatment for chronic pain: Individual vs group interventions
	Search terms	Items found
The search result, usually found at the end of the documentation, forms the list of abstracts /de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Population:
1.	'pain'/exp OR ‘Fibromyalgia’/exp OR fibromyalgia*:ti,ab,kw OR (Chronic NEAR/3 (pain OR discomfort OR ache)):ti,ab,kw	1 436 957
Intervention:
2.	(individual NEAR/3 (vs OR versus OR compared OR difference* OR comparison OR effective) NEAR/3 group):ti,ab,kw OR (group NEAR/3 (vs OR versus OR compared OR difference* OR comparison OR effective) NEAR/3 individual):ti,ab,kw OR (“Individual and group” OR “group and individual” OR “Individual or group” OR “group or individual”):ti,ab,kw	8 201
3.	'psychotherapy'/exp OR 'cognitive therapy'/exp OR 'behavior therapy'/exp OR ((Behavio?r* OR cognitive) NEAR/2 therap):ti,ab,kw OR (acceptance NEAR/2 (commitment OR therap)):ti,ab,kw OR psychotherap:ti,ab,kw OR (psychological NEAR/3 (treatment or therap*)):ti,ab,kw	309 906
Final	1 AND 2 AND 3	100

PsycINFO via ebsco.com 2021-05-19

Psychological treatment for chronic pain: Individual vs group interventions
	Search terms	Items found
The search result, usually found at the end of the documentation, forms the list of abstracts AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation
Population:
1.	(DE "Pain") OR (DE "Fibromyalgia") OR (TI (fibromyalgia* OR (Chronic N3 (pain OR discomfort OR ache)))) OR (AB (fibromyalgia* OR (Chronic N3 (pain OR discomfort OR ache))))	54 966
Intervention:
2.	(TI ((individual N3 (vs OR versus OR compared OR difference* OR comparison OR effective) N3 group) OR (group N3 (vs OR versus OR compared OR difference* OR comparison OR effective) N3 individual) OR (“Individual and group” OR “group and individual” OR “Individual or group” OR “group or individual”))) OR (AB ((individual N3 (vs OR versus OR compared OR difference* OR comparison OR effective) N3 group) OR (group N3 (vs OR versus OR compared OR difference* OR comparison OR effective) N3 individual) OR (“Individual and group” OR “group and individual” OR “Individual or group” OR “group or individual”)))	14 679
3.	(DE "Psychotherapy") OR (DE "Cognitive Therapy") OR (TI (((Behavio?r* OR cognitive) N2 therap) OR (acceptance N2 (commitment OR therap)) OR psychotherap* OR (psychological N3 (treatment* or therap)))) OR (AB (((Behavio?r OR cognitive) N2 therap) OR (acceptance N2 (commitment OR therap)) OR psychotherap* OR (psychological N3 (treatment* or therap*))))	182 015
Final	1 AND 2 AND 3	25

Medline via ebsco.com 2021-05-19

Psychological treatment for chronic pain: Individual vs group interventions
	Search terms	Items found
The search result, usually found at the end of the documentation, forms the list of abstracts AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:
1.	MH ”pain+” OR MH "Fibromyalgia" OR (TI (fibromyalgia* OR (Chronic N3 (pain OR discomfort OR ache)))) OR (AB (fibromyalgia* OR (Chronic N3 (pain OR discomfort OR ache))))	887 570
Intervention:
2.	(TI ((individual N3 (vs OR versus OR compared OR difference* OR comparison OR effective) N3 group) OR (group N3 (vs OR versus OR compared OR difference* OR comparison OR effective) N3 individual) OR (“Individual and group” OR “group and individual” OR “Individual or group” OR “group or individual”))) OR (AB ((individual N3 (vs OR versus OR compared OR difference* OR comparison OR effective) N3 group) OR (group N3 (vs OR versus OR compared OR difference* OR comparison OR effective) N3 individual) OR (“Individual and group” OR “group and individual” OR “Individual or group” OR “group or individual”)))	22 420
3.	MH "Psychotherapy+" OR MH "Cognitive Behavioral Therapy+" OR (TI (((Behavio?r* OR cognitive) N2 therap) OR (acceptance N2 (commitment OR therap)) OR psychotherap* OR (psychological N3 (treatment* or therap)))) OR (AB (((Behavio?r OR cognitive) N2 therap) OR (acceptance N2 (commitment OR therap)) OR psychotherap* OR (psychological N3 (treatment* or therap*))))	465 981
Final	1 AND 2 AND 3	78

Page published July 5, 2021

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