The Effect of Psychological Interventions on the Prevention of Chronic Pain in Adults: A Systematic Review and Meta-analysis.

Objective Up to 50% of patients develop high-impact chronic pain after an acute care experience and many psychological variables have been identified in this process. We conducted a systematic review and meta-analysis of randomized controlled trials to assess the effect of psychological interventions within 3 months after pain onset. Methods We searched databases for articles published until July 2019. We used standardized mean differences with 95% confidence internals to assess treatment effect. Results Eighteen trials were found eligible; 11 of which were included in the meta-analyses. Trials were mainly performed in back pain patients in the middle to late adulthood. Regarding pain intensity, the effect of psychological interventions compared to standard treatments was non-significant at 3 months, 6 months and 12 months. We found a moderate significant effect size in favor of psychological interventions compared to standard treatments with regard to disability at 12 months and a small significant effect with regard to coping with pain at 3 months when compared to information. Most of the meta-analyses' findings were associated with a low level of evidence. Discussion This systematic review and meta-analysis showed no significant effect of psychological interventions on pain intensity. A positive and significant trend related to these interventions was shown on disability and coping with pain, when compared to standard treatment and information, respectively. However, these findings must be interpretated with caution considering the limited sample of trials. More rigorous RCTs performed in patients with a high-risk psychological profile are required to elucidate the efficacy of psychological interventions in preventing chronic pain.