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Original Article
- Meta- analysis of Psychosocial Interventions to Reduce Pain in Patients with Cancer
- Pok Ja Oh, Suk Jung Han
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Journal of Korean Academy of Nursing 2013;43(5):658-668.
DOI: https://doi.org/10.4040/jkan.2013.43.5.658
Published online: October 15, 2013
Department of Nursing, Sahmyook University, Seoul, Korea
Department of Nursing, Sahmyook University, Seoul, Korea
- Address reprint requests to : Oh, Pok Ja Department of Nursing, Sahmyook University, Hwarangro-815, Nowon-gu, Seoul 139-742, Korea Tel: +82-2-3399-1589 Fax: +82-2-3399-1594 E-mail: ohpj@syu.ac.kr
• Received: April 2, 2013 • Revised: April 14, 2013 • Accepted: August 29, 2013
Copyright © 2013 Korean Society of Nursing Science
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
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Purpose
- The purpose of this study was to investigate the effects of psychosocial interventions on pain in cancer patients.
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Methods
- Eight studies published between 1980 and 2012 in Korean and ten studies published between 2002 and 2012 in English met the inclusion criteria with a total of 1539 participants. Methodological quality assessed by Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. The data were analyzed by the RevMan 5.2 program of Cochrane library.
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Results
- Overall, study quality was moderate to high. Effect sizes were heterogeneous and subgroup analysis was done. Cognitive behavioral therapy (CBT) were effective for pain (ES= -0.35; 95% CI= -0.56, -0.13). Pain education studies measured with NRS and VAS were effective for pain (ES= -0.77; 95% CI= -1.01, -0.52). Publication bias was not detected.
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Conclusion
- This study support the use of psychosocial interventions administered to cancer patients for their pain management. However, more well-designed studies are needed.
Figure 2.Forest plot of effect size and 95% CI by cognitive behavioral therapy on pain & funnel plot of effective sizes by standard error for pain.
Figure 3.Forest plot of effect size and 95% CI by education interventions on pain & funnel plot of effective sizes by standard error for pain.
Figure 4.Forest plot of effect size and 95% CI by psychosocial intervention on pain & funnel plot of effective sizes by standard error for pain.
Table 1.Characteristics of Included Studies (N=18)
| References | Sources | Designs | Subjects (stage/analgesic) | Sample sizes | Interventions | Outcomes (Timing of measurement) | Scale | Direction of effect | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Exp. (n) | Cont. (n) | Name/type | Weeks/Number of Sessions/Min | |||||||
| Bordeleau (2003)* | Journal (non-nursing) | RCT | Metastatic breast cancer (unclear/unclear) | 80 | 36 | Supportive-expressive therapy/ group | 48/48/90 | Pain severity (4,8,12 min) | Symptom subscales of EORTC QLQ-C30 | No diff. |
| Chujo et al. (2005)¶ | Journal (non-nursing) | ) NRCCT | Breast cancer patient (recurrence/unclear) | ) 19 | 9 | Psychosocial group intervention/ group | 6/6/90 | Pain severity (immediately, 3,6 min) | EORTC QLQ-C30/ Br23 | No diff. |
| Dolbeaul (2009)* § | Journal (non-nursing) | RCT) | Cancer patient (ealry/unclear) | 81 | 87 | Psycho-educational group/group | 8/8/120 | Pain severity (immediately) | EORTC QLQ-Br23 | − |
| Goung (2003)¶ # | Master's (nursing) | NRCCT | Stomach cancer (terminal/narcotics) | 32 | 32 | Pain control education/ individual | 1/1/30-40 | Worst/Least/mean/ present pain (1 wk) | BPI-K | −/No diff./ -/No diff. |
| Hong (2010)¶ # | Master's (nursing) | NRCCT | Colon cancer patient (unclear/PCA) | 21 | 21 | Recovery nursing intervention/ individual | 4/4/30-40 | Pain severity (immediately) | NRS | − |
| Jeong (2011)¶ # | Master's (psychology) | NRCCT | Cancer patient (unclear/no | 8 | 8 | MBSR/group | 8/8/90 | Pain severity (immediately) | PPI/VAS | −/- |
| analgesics) | ||||||||||
| Kim (2009)¶ ** | Master's (nursing) | NRCCT | Cancer patients (3,4/narcotics) | 23 | 23 | Pain management education/group | unclear/9/30 | Analgesic use/ pain severity(1 wk) | BPI-K/NRS | +/- |
| Kroenke et al. (2010)‡§ | Journal (non-nursing) | ) RCT ( | Cancer patient (unclear/analgesics) | ) 137 | 137 | Telecare management | 12/3/ unclear(phone) | Pain severity (1,3,6,12 min) | BPI | − |
| Kwon, Whang, & Kim (2002)¶ ** | Journal (nursing) | NRCCT | Home cancer patient (terminal/unclear) | 16 | 16 | Pain management education/ individual | 1/1/30 | Pain severity (2-3 wks) | Patients Outcome Questionnaire | − |
| Lai et al. (2004)§ | Journal (nursing) | RCT | Cancer patient (2-4/unclear) | 15 | 15 | Brief pain education/group | 1/5/10-15 | Pain severity (immediately) | BPI-T | − |
| Lee (2008)¶ ** | Master's (nursing) | NRCCT | Gastric Cancer Patient (unclear/PCA) | 40 | 40 | Structured PCA education/ individual | 1/1/20 | Analgesic use/ pain severity (1 wk) | VAS | − |
| Lengacher et al. (2010) | Journal (nursing) | RCT | Breast cancer patient (0-4/unclear) | 40 | 42 | MBSR/group | 6/6/120 | Pain severity (within 2 wks) | MDASI | − |
| Shin & Lee (2003)¶ # | Journal (nursing) | NRCCT | Cancer patient (unclear/no drug) | 25 | 25 | Cancer pain management education/ Individual | unclear/unclear/ 20-30 | Pain severity (2 wks) | VAS | No diff. |
| Thomas et al. (2012)* †‡ | Journal (nursing) | RCT | Cancer patient (unclear/unclear) | Coach: 64 Education: 75 | : 88 | Education or motivational-interviewing–based coaching/group | 6/4/30(coaching, education-video) | ,) Body pain (6 wks) | BPI | No diff. |
| van der Peet et al. (2009)§ | Journal (nursing) | RCT | Cancer patient(unclear/pain score of 4 or higher) | 39 n | 44 | Intensive nursing-based pain education program/ individual | / 3/3/60-90 | Pain severity (4, 8 wks) | Ferrell's pain questionnaire | −/No diff. |
| Yates et al. (2004)†§ | Journal (nursing) | RCT | Cancer patient (unclear/unclear) | 87 | 79 | Pain management intervention/ Individual | 1/2/30 | Pain severity (1, 8 wks) | BPI | − |
| Yildirim & Cicek (2009)§ | Journal (nursing) | RCT | Cancer patient (unclear/unclear) | 20 | 20 | Pain education program/ individual | 3&7days/ unclear/ 30-40 | Present pain/worst pain/least pain (2, 4, 8 wks) | MPQ/NRS | −/No diff./- |
| Yoo (2005)¶# | Doctoral (nursing) | NRCCT | Lung cancer patient (unclear/unclear) | 30 | 34 | Web based education program/ individual | 1/1/15 / | Pain severity (3 wks) | NRS | − |
Exp.=Experimental group; Cont.=Control group; diff.=difference; RCT=Randomized controlled trials; NRCCT=Non-randomized controlled clinical trial; EORTC QLQ-C30=European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30; EORTC QLQ-BR23=European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Breast cancer module 23; VAS=Visual Analog Scale; NRS=Numeric Rating Scale; PPI=Present Pain Inventory; BPI-K=Korean Version of Brief Pain Inventory; PMI=Pain Management Index; BPI=Brief Pain Inventory; BPI-T=Brief Pain Inventory-Short Form Taiwanese version; MDASI=M.D. Anderson Symptom Inventory; MBSR=Mindfulness-Based Stress Reduction; SF-36=Short Form-36; MPQ=McGill Pain Questionnaire; BQ-r=Barrier Questionnaire-Revised; BQ-K=Barriers Questionnaire Korean version; *Allocation concealment;
†Blinding(performance);
‡Blinding(detection);
§Low risk of attrition;
¶Low risk of selection bias;
#High risk of performance bias; **Low risk of detection bias.
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XML DownloadMeta- analysis of Psychosocial Interventions to Reduce Pain in Patients with Cancer
Figure 1. Flow of studies included from database search.
Figure 2. Forest plot of effect size and 95% CI by cognitive behavioral therapy on pain & funnel plot of effective sizes by standard error for pain.
Figure 3. Forest plot of effect size and 95% CI by education interventions on pain & funnel plot of effective sizes by standard error for pain.
Figure 4. Forest plot of effect size and 95% CI by psychosocial intervention on pain & funnel plot of effective sizes by standard error for pain.
Figure 1.
Figure 2.
Figure 3.
Figure 4.
Meta- analysis of Psychosocial Interventions to Reduce Pain in Patients with Cancer
Characteristics of Included Studies (N=18)
| References | Sources | Designs | Subjects (stage/analgesic) | Sample sizes | Interventions | Outcomes (Timing of measurement) | Scale | Direction of effect | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Exp. (n) | Cont. (n) | Name/type | Weeks/Number of Sessions/Min | |||||||
| Bordeleau (2003)* | Journal (non-nursing) | RCT | Metastatic breast cancer (unclear/unclear) | 80 | 36 | Supportive-expressive therapy/ group | 48/48/90 | Pain severity (4,8,12 min) | Symptom subscales of EORTC QLQ-C30 | No diff. |
| Chujo et al. (2005) |
Journal (non-nursing) | ) NRCCT | Breast cancer patient (recurrence/unclear) | ) 19 | 9 | Psychosocial group intervention/ group | 6/6/90 | Pain severity (immediately, 3,6 min) | EORTC QLQ-C30/ Br23 | No diff. |
| Dolbeaul (2009)* |
Journal (non-nursing) | RCT) | Cancer patient (ealry/unclear) | 81 | 87 | Psycho-educational group/group | 8/8/120 | Pain severity (immediately) | EORTC QLQ-Br23 | − |
| Goung (2003) |
Master's (nursing) | NRCCT | Stomach cancer (terminal/narcotics) | 32 | 32 | Pain control education/ individual | 1/1/30-40 | Worst/Least/mean/ present pain (1 wk) | BPI-K | −/No diff./ -/No diff. |
| Hong (2010) |
Master's (nursing) | NRCCT | Colon cancer patient (unclear/PCA) | 21 | 21 | Recovery nursing intervention/ individual | 4/4/30-40 | Pain severity (immediately) | NRS | − |
| Jeong (2011) |
Master's (psychology) | NRCCT | Cancer patient (unclear/no | 8 | 8 | MBSR/group | 8/8/90 | Pain severity (immediately) | PPI/VAS | −/- |
| analgesics) | ||||||||||
| Kim (2009) |
Master's (nursing) | NRCCT | Cancer patients (3,4/narcotics) | 23 | 23 | Pain management education/group | unclear/9/30 | Analgesic use/ pain severity(1 wk) | BPI-K/NRS | +/- |
| Kroenke et al. (2010)‡§ | Journal (non-nursing) | ) RCT ( | Cancer patient (unclear/analgesics) | ) 137 | 137 | Telecare management | 12/3/ unclear(phone) | Pain severity (1,3,6,12 min) | BPI | − |
| Kwon, Whang, & Kim (2002) |
Journal (nursing) | NRCCT | Home cancer patient (terminal/unclear) | 16 | 16 | Pain management education/ individual | 1/1/30 | Pain severity (2-3 wks) | Patients Outcome Questionnaire | − |
| Lai et al. (2004) |
Journal (nursing) | RCT | Cancer patient (2-4/unclear) | 15 | 15 | Brief pain education/group | 1/5/10-15 | Pain severity (immediately) | BPI-T | − |
| Lee (2008) |
Master's (nursing) | NRCCT | Gastric Cancer Patient (unclear/PCA) | 40 | 40 | Structured PCA education/ individual | 1/1/20 | Analgesic use/ pain severity (1 wk) | VAS | − |
| Lengacher et al. (2010) | Journal (nursing) | RCT | Breast cancer patient (0-4/unclear) | 40 | 42 | MBSR/group | 6/6/120 | Pain severity (within 2 wks) | MDASI | − |
| Shin & Lee (2003) |
Journal (nursing) | NRCCT | Cancer patient (unclear/no drug) | 25 | 25 | Cancer pain management education/ Individual | unclear/unclear/ 20-30 | Pain severity (2 wks) | VAS | No diff. |
| Thomas et al. (2012)* †‡ | Journal (nursing) | RCT | Cancer patient (unclear/unclear) | Coach: 64 Education: 75 | : 88 | Education or motivational-interviewing–based coaching/group | 6/4/30(coaching, education-video) | ,) Body pain (6 wks) | BPI | No diff. |
| van der Peet et al. (2009) |
Journal (nursing) | RCT | Cancer patient(unclear/pain score of 4 or higher) | 39 n | 44 | Intensive nursing-based pain education program/ individual | / 3/3/60-90 | Pain severity (4, 8 wks) | Ferrell's pain questionnaire | −/No diff. |
| Yates et al. (2004)†§ | Journal (nursing) | RCT | Cancer patient (unclear/unclear) | 87 | 79 | Pain management intervention/ Individual | 1/2/30 | Pain severity (1, 8 wks) | BPI | − |
| Yildirim & Cicek (2009) |
Journal (nursing) | RCT | Cancer patient (unclear/unclear) | 20 | 20 | Pain education program/ individual | 3&7days/ unclear/ 30-40 | Present pain/worst pain/least pain (2, 4, 8 wks) | MPQ/NRS | −/No diff./- |
| Yoo (2005)¶# | Doctoral (nursing) | NRCCT | Lung cancer patient (unclear/unclear) | 30 | 34 | Web based education program/ individual | 1/1/15 / | Pain severity (3 wks) | NRS | − |
Exp.=Experimental group; Cont.=Control group; diff.=difference; RCT=Randomized controlled trials; NRCCT=Non-randomized controlled clinical trial; EORTC QLQ-C30=European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30; EORTC QLQ-BR23=European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Breast cancer module 23; VAS=Visual Analog Scale; NRS=Numeric Rating Scale; PPI=Present Pain Inventory; BPI-K=Korean Version of Brief Pain Inventory; PMI=Pain Management Index; BPI=Brief Pain Inventory; BPI-T=Brief Pain Inventory-Short Form Taiwanese version; MDASI=M.D. Anderson Symptom Inventory; MBSR=Mindfulness-Based Stress Reduction; SF-36=Short Form-36; MPQ=McGill Pain Questionnaire; BQ-r=Barrier Questionnaire-Revised; BQ-K=Barriers Questionnaire Korean version; *Allocation concealment;
†Blinding(performance);
‡Blinding(detection);
§Low risk of attrition;
¶Low risk of selection bias;
#High risk of performance bias; **Low risk of detection bias.
Table 1. Characteristics of Included Studies (N=18)
Exp.=Experimental group; Cont.=Control group; diff.=difference; RCT=Randomized controlled trials; NRCCT=Non-randomized controlled clinical trial; EORTC QLQ-C30=European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30; EORTC QLQ-BR23=European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Breast cancer module 23; VAS=Visual Analog Scale; NRS=Numeric Rating Scale; PPI=Present Pain Inventory; BPI-K=Korean Version of Brief Pain Inventory; PMI=Pain Management Index; BPI=Brief Pain Inventory; BPI-T=Brief Pain Inventory-Short Form Taiwanese version; MDASI=M.D. Anderson Symptom Inventory; MBSR=Mindfulness-Based Stress Reduction; SF-36=Short Form-36; MPQ=McGill Pain Questionnaire; BQ-r=Barrier Questionnaire-Revised; BQ-K=Barriers Questionnaire Korean version; *Allocation concealment; Blinding(performance); Blinding(detection); Low risk of attrition; Low risk of selection bias; High risk of performance bias; **Low risk of detection bias.
