Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.
Psychological Medicine, Cambridgeshire and Peterborough Foundation Trust, Cambridge, UK.
Disabil Rehabil. 2024 Oct;46(21):4877-4888. doi: 10.1080/09638288.2023.2283113. Epub 2023 Nov 29.
The aim of this systematic review was to synthesise the research identifying possible influences on CBT outcomes in chronic pain. Variations in the effectiveness of psychological therapies, such as CBT, in chronic pain have led to research investigating predictors of improved treatment outcomes.
We identified randomised controlled and cohort studies of CBT for chronic pain, published between 1974 to 2nd August 2023, which identified predictors of CBT outcomes.
Nineteen studies were included in the review. Baseline sociodemographic, physical and emotional factors that influence the outcomes of CBT for chronic pain were identified. The most commonly reported predictors of CBT outcome, with medium to large effect sizes, were anxiety, depression and negative cognitions about pain and coping. Sociodemographic predictors of outcomes demonstrated small effects and lacked replicability.
There was variability across study designs, CBT delivery and outcomes measures. Further research is needed in chronic pain to identify the predictive factors which influence treatment outcomes, and consistency across study designs and outcome variables is needed to reduce heterogeneity.
本系统评价旨在综合研究确定慢性疼痛中 CBT 结果的可能影响因素。CBT 等心理疗法在慢性疼痛中的有效性存在差异，因此开展了研究以调查改善治疗结果的预测因素。
我们确定了 1974 年至 2023 年 8 月 2 日期间发表的关于 CBT 治疗慢性疼痛的随机对照和队列研究，这些研究确定了 CBT 结果的预测因素。
共有 19 项研究纳入了本次综述。确定了影响 CBT 治疗慢性疼痛结果的基线社会人口学、身体和情绪因素。报告最多的预测 CBT 结果的因素是焦虑、抑郁以及对疼痛和应对方式的消极认知，这些因素具有中到大量的效应大小。社会人口学预测因素的效果较小，且缺乏可重复性。
研究设计、CBT 实施和结果测量存在差异。慢性疼痛领域需要进一步研究以确定影响治疗结果的预测因素，并且需要在研究设计和结果变量方面保持一致性，以减少异质性。
