Meta-Analysis of the Effect of Psychoeducational Interventions on Pain in Adults With Cancer

Abstract

To determine the effect of psychoeducational interventions on pain in adults with cancer. 25 intervention studies published from 1978-2001. When analyzed across all studies, a statistically significant, beneficial effect on pain was found. However, threats to validity were present in some studies. The most serious of these involved a lack of random assignment to treatment condition and a floor effect on pain. When limited to the studies with the best methodologic quality, the effect on pain continued to be statistically significant. Effect on pain by type of treatment was examined and found to be somewhat variable and limited by the small number of studies testing each type of treatment. Methodologic quality was variable. Reasonably strong evidence exists for relaxation-based cognitive-behavioral interventions, education about analgesic usage, and supportive counseling. Minimal data were available about the relative effectiveness of different types of psychoeducational interventions because few studies included within-study contrasts of different experimental interventions and usual care was not well documented. Psychoeducational interventions are not a substitute for analgesics, but they may serve as adjuvant therapy. Assessment and clinical judgment are critical. The intervention must be acceptable to patients and not too burdensome for patients in pain to use.