What is the clinical effectiveness of cognitive behavioural therapy for chronic non-cancer pain?
There were five systematic reviews included in this report, four of which were Cochrane reviews. Four of the five included systematic reviews had one weakness in the AMSTAR critical domains. The clinical effectiveness of cognitive behavioural therapy was assessed in several populations. Cognitive behavioural therapy was associated with a reduction in pain or pain frequency in children with chronic headache, patients with chronic low back pain, patients with chronic neck pain, and patients with spinal cord injury and chronic pain, compared with wait-list control, no treatment, or standard care. In addition, cognitive behavioural therapy was also associated with a reduction in physical impairment in children with chronic headache, a reduction in disability and an improvement in quality of life in patients with chronic neck pain, and a reduction in kinesiophobia in patients with chronic neck pain. However, a significant pain reduction was not observed in children with chronic headache in smaller trials (fewer than 20 patients per arm) and in patients with spinal cord injury three months after intervention, compared with the control groups. Despite the inclusion of multiple systematic reviews, this report had limitations, such as the limited number of relevant primary studies identified within those systematic reviews, short durations of follow-up, and unclear definitions of chronic pain or cognitive behavioural therapy in certain studies. Further research on cognitive behavioural therapy in Canada may help reduce uncertainty.