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Psychological treatment for people with musculoskeletal pain 2

Part 2 of 2
Published on July 30, 2015   42 min

A selection of talks on Neuroscience

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0:04
There is now a large body of evidence on interventions that really did offer psychological treatment to people with chronic pain and low back pain within this. There were several systematic reviews. Most of the trials included cognitive behavioral therapy, not necessarily delivered by a psychologist.
0:29
The systematic reviews report that the effect size is shrinking. In other words, the original systematic review that looked at all of this reported an effect size of around 0.5, which is a respectable moderate effect size for improvement. But as trials get better, the effect size gets smaller, and it's now only around 0.2. We're getting much better at doing trials. The authors of the most recent systematic review in 2012 report that the methodology is improving all the time. However, the delivery of treatment, what is actually given to patients, is not improving. The dose is still diluted. Fidelity and integrity are not evident.
1:17
The conclusion from systematic reviews is that cognitive behavioral therapy is effective. It improves mood. It changes beliefs. It increases social and work engagement. It decreases disability, and it improves function, a little. This is disappointing, considering that the psychological obstacles to recovery are robust, and we would think that psychological interventions that try and tackle these would show a medium to large effect size, but they don't.

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Psychological treatment for people with musculoskeletal pain 2

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