How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment

Carlos Murillo, Tat-Thang Vo, Stijn Vansteelandt, Lauren E Harrison, Barbara Cagnie, Iris Coppieters, Marjolein Chys, Inge Timmers, Mira Meeus*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

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Abstract

Psychologically based interventions aim to improve pain-related functioning by targeting pain-related fears, cognitions and behaviors. Mediation and moderation analyses permit further examination of the effect of treatment on an outcome. This systematic review and meta-analysis aims to synthetize the evidence of specific mediators and moderators (i.e., treatment targets) of psychologically based treatment effects on pain and disability. A total of 28 mediation and 11 moderation analyses were included. Thirteen mediation studies were included in a meta-analysis, and the rest was narratively synthetized. Reductions in pain-related fear (indirect effect [IE]: -0.07; 95% confidence interval [CI]: -0.11, -0.04) and catastrophizing (IE: -0.07; 95%CI: -0.14, -0.00), as well as increases in self-efficacy (IE: -0.07; 95%CI: -0.11, -0.04), mediated effects of cognitive behavioral therapy on disability but not on pain intensity, when compared to control treatments. Enhancing pain acceptance (IE: -0.17; 95%CI: -0.31, -0.03) and psychological flexibility (IE: -0.30; 95%CI: -0.41, -0.18) mediated acceptance and commitment therapy effects on disability. The narrative synthesis showed conflicting evidence, which did not support a robust moderated effect for any of the examined constructs. Overall, the methodological quality regarding mediation was low, and some key pitfalls are highlighted alongside recommendations to provide a platform for future research.

Original languageEnglish
Article number102160
Number of pages23
JournalClinical Psychology Review
Volume94
DOIs
Publication statusPublished - Jun 2022

Keywords

  • Acceptance and Commitment Therapy
  • Chronic Pain/psychology
  • Cognitive Behavioral Therapy
  • Humans
  • Musculoskeletal Pain/psychology
  • Self Efficacy
  • CONTROLLED-TRIAL
  • Chronic musculoskeletal pain
  • COMMITMENT THERAPY
  • SELF-EFFICACY
  • PREDICTING RESPONSE
  • TESTING MEDIATION
  • LOW-BACK-PAIN
  • meta-analysis
  • Systematic review
  • SECONDARY ANALYSIS
  • Moderation analysis
  • Psychologically based interventions
  • COGNITIVE-BEHAVIORAL THERAPY
  • REDUCE PAIN
  • GRADED ACTIVITY
  • Mediation analysis

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