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JCO Early Release, published online ahead of print Jan 17 2012
Journal of Clinical Oncology, 10.1200/JCO.2011.37.0437

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Palliative and Supportive Care

Submitted May 13, 2011; accepted November 8, 2011.

Meta-Analysis of Psychosocial Interventions to Reduce Pain in Patients With Cancer

Sherri Sheinfeld Gorin, Paul Krebs, Hoda Badr, Elizabeth Amy Janke, Heather S.L. Jim, Bonnie Spring, David C. Mohr, Mark A. Berendsen, Paul B. Jacobsen

Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL.

Corresponding author: Paul Jacobsen, PhD, Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612; e-mail: paul.jacobsen{at}moffitt.org.

Purpose Pain is one of the most common, burdensome, and feared symptoms experienced by patients with cancer. American Pain Society standards for pain management in cancer recommend both pharmacologic and psychosocial approaches. To obtain a current, stable, and comprehensive estimate of the effect of psychosocial interventions on pain—an important clinical topic—we conducted a meta-analysis of randomized controlled studies among adult patients with cancer published between 1966 and 2010.

Methods Three pairs of raters independently reviewed 1,681 abstracts, with a systematic process for reconciling disagreement, yielding 42 papers, of which 37 had sufficient data for meta-analysis. Studies were assessed for quality using a modified seven-item Physiotherapy Evidence Database (PEDro) coding scheme. Pain severity and interference were primary outcome measures.

Results Study participants (N = 4,199) were primarily women (66%) and white (72%). The weighted averaged effect size across studies for pain severity (38 comparisons) was 0.34 (95% CI, 0.23 to 0.46; P < .001), and the effect size for pain interference (four comparisons) was 0.40 (95% CI, 0.21 to 0.60; P < .001). Studies that monitored whether treatment was delivered as intended had larger effects than those that did not (P = .04).

Conclusion Psychosocial interventions had medium-size effects on both pain severity and interference. These robust findings support the systematic implementation of quality-controlled psychosocial interventions as part of a multimodal approach to the management of pain in patients with cancer.


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