Psychological Therapies for the Management of Pain Following Musculoskeletal Injury: A Systematic Review and Meta-Analysis

Objective(s)To systematically review and meta-analyze the effects of psychological interventions on pain-related outcomes following musculoskeletal injury (e.g., fracture, sprain). Musculoskeletal injury occurs in nearly one billion people per year and is a leading cause of chronic pain and disability worldwide.Data SourcesWe searched EMBASE, MEDLINE, PubMed, and PsycINFO (inception to April 2021) to identify studies that referenced pain, musculoskeletal injury, and psychological intervention at any age.Study SelectionWe identified and screened 8,498 records; reviewed 117 full texts; and included 27 eligible studies that delivered a psychological intervention targeting pain after musculoskeletal injury. Two authors independently reviewed records at each stage.Data ExtractionWe extracted characteristics related to study design, injury and intervention; outcome data; and risk of bias (using the Cochrane Risk of Bias tool).Data SynthesisTwenty-two randomized controlled trials (RCTs; N = 1,882) and 8 non-randomized trials (N = 416) were included. There was substantial variability in type, duration, delivery, and timing of intervention. Intervention groups had lower disability (standardized mean difference = -0.26, 95% CI [-0.49, -0.04]), depression (-0.46 [-0.65, -0.27]), anxiety (-0.41 [-0.63, -0.19]), and PTSD symptoms (-0.33 [-0.58, -0.08]) immediately post-treatment compared to control. There were no group differences in pain intensity (-0.19 [-0.41, 0.03]). At 6-month follow-up, only depression (-0.35 [-0.68, -0.02) was lower following intervention. There were insufficient data to meta-analyze 12-month follow-up data. Most studies were judged as high risk of bias.ConclusionsPsychological interventions may be effective for improving disability and psychological distress immediately following musculoskeletal injury. However, extant literature is small in size, heterogenous, and characterized by poor quality studies. Overall, the interventions did not result in improved pain intensity or enduring treatment effects. Large scale and methodologically rigorous RCTs are needed to address these gaps and improve outcomes following injury.Author(s) DisclosuresStephen Wegener has a conflict of interest with Medline (speaker/honoraria). The authors declare no other conflicts of interest.