What is the clinical effectiveness of psychological therapies for the treatment of individuals with acute or subacute musculoskeletal pain?
What are the evidence-based guidelines regarding the use of psychological therapies for the treatment of individuals with acute or subacute musculoskeletal pain?
A total of seven relevant publications were included in this report: five systematic reviews (two with meta-analysis), one cluster randomized controlled trial and one evidence-based guideline. Two of the five systematic reviews were aimed at postoperative pain; the remaining three were aimed at subacute low back pain (7–12 weeks), subacute neck pain (≤ 3 months), and all types of musculoskeletal pain. The randomized controlled trial was aimed at subacute low back pain (2–12 weeks), and the guideline provided recommendations on all forms of low back pain. Overall, cognitive-behavioral therapy and low back pain were the most studied psychological intervention and musculoskeletal condition, respectively.
Cognitive-behavioral therapy combined with physiotherapy appeared to provide functional improvements following back-surgery, without any impact on pain resolution. Psychotherapies based on relaxation or mindfulness techniques showed mixed results on pain following knee surgery; a firm conclusion could not be drawn due to widely variable intervention scheme.
With respect to musculoskeletal pain, psychotherapy combined with physiotherapy was shown to improve pain and disability resulting from musculoskeletal pain overall; however, these benefits were not found when low back pain, neck and whiplash-associated pain, and osteoarthritis-related pain were investigated separately. Cognitive-behavioral therapy was found to be beneficial in subacute neck pain, although the evidence was of low quality. There was some evidence that cognitive-behavioral therapies may reduce disability and improve body functions in patients with subacute low back pain, particularly when integrated with physiotherapy and personalized to patients’ context; however, the effects on pain resolution was less pronounced. The clinical guideline made no reference to psychotherapies for the management of short-term low back pain, and instead recommended other forms of non-pharmacologic therapies since most patients achieve resolution naturally.
Overall, the included studies showed substantial heterogeneity in psychotherapies used and outcomes measures, making it difficult to compare findings across studies and to obtain an overall picture of the various psychotherapies for different types of musculoskeletal pain. Nevertheless, psychological therapies, most notably cognitive-behavioral therapy, has some clinical benefits in improving short-term pain and body functions resulting from surgery or musculoskeletal conditions when combined with other interventions aimed at improving body functions e.g. physiotherapy.