The Impact of Psychological Interventions on Posttraumatic Stress Disorder and Pain Symptoms: A Systematic Review and Meta-Analysis.
Author: Goldstein E1, McDonnell C2, Atchley R3, Dorado K2, Bedford C3, Brown RL4, Zgierska AE1
Affiliation:
1University of Wisconsin-Madison School of Medicine and Public Health Department of Family Medicine and Community Health.
2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School.
3University of Utah College of Social Work.
4University of Wisconsin-Madison Schools of Nursing and School of Medicine and Public Health - Design and Statistics Unit.
Conference/Journal: Clin J Pain.
Date published: 2019 May 27
Other:
Special Notes: doi: 10.1097/AJP.0000000000000730. [Epub ahead of print] , Word Count: 241
OBJECTIVES: Posttraumatic stress disorder (PTSD) and pain often co-occur, introducing clinical challenges and economic burden. Psychological treatments are considered effective for each condition, yet it is not known which therapies have the potential to concurrently address PTSD and pain-related symptoms.
METHODS: To conduct a systematic review and meta-analysis, databases were searched for articles published between January 2007 and December 2017 describing results from clinical trials of interventions addressing PTSD and pain-related symptoms in adults. Two independent reviewers finalized data extraction and risk of bias assessments. A random effects model was used for meta-analysis and to calculate pooled and subgroup effect sizes (ESs) of psychological-only (single modality) and multimodal interventions.
RESULTS: Eighteen trials (7 uncontrolled, 11 randomized controlled trials, RCTs), totaling 1,583 participants, were included in the systematic review. RCT intervention types included exposure-based, cognitive-behavioral, and mindfulness-based therapies. Data from 10 RCTs (N=1,435) were available for meta-analysis, which demonstrated moderate effect for reduced PTSD severity (ES=-0.55, CI: -0.83, -0.26) and non-significant effect for pain intensity (ES=-0.14, CI: -0.43, 0.15) and pain interference (ES=-0.07, CI: -0.35, 0.20) outcomes. Findings from uncontrolled trials supported meta-analytic results from RCTs. Using GRADE assessment, the quality of evidence was deemed as moderate for RCTs and low for non-RCTs.
DISCUSSION: Findings indicated that the majority of the interventions appeared to have greater impact on reducing PTSD rather than pain-related symptoms. There remains a need to further develop interventions that consistently impact PTSD and pain-related outcomes when these two conditions co-occur.
PMID: 31145146 DOI: 10.1097/AJP.0000000000000730
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