Psychological treatments for chronic pain involving damage or disease to nerves responsible for pain

Many people experience pain from an injury or disease that goes away within three months, but for some people the pain continues. When the pain involves changes to nerves we call the pain 'neuropathic'. Although the condition is increasingly common, the treatments we have help only a few people. Following unsuccessful surgical or pharmacological treatment, people with chronic pain may be offered psychologically-based rehabilitation to improve their quality of life. While we know that this can help people with other types of chronic pain, this treatment for neuropathic pain alone has received less research attention.

In this review, we were interested in finding out whether psychological treatments improve pain, distress, and disability in people with chronic neuropathic pain. We searched the academic literature to March 2015 and identified two randomised controlled trials (the gold standard design for clinical trials) on psychological interventions for chronic neuropathic pain. The two studies included 105 participants: one trial of 61 people with pain from spinal cord injury and the other of 44 people with burning mouth syndrome.

Our confidence in the results of the individual trials was limited by several potential biases in how they were conducted. We were not able to analyse the results of the two trials together because the experiences of people with spinal cord injury or burning mouth are too different from each other. On their own, the trials were too small for us to undertake any statistical analysis. However, neither trial found any clear benefit of treatment. We conclude that there is currently no evidence that will help practitioners and patients to decide whether to use these treatments. We discuss what studies are needed.

Authors' conclusions: 

There is insufficient evidence of the efficacy and safety of psychological interventions for chronic neuropathic pain. The two available studies show no benefit of treatment over either waiting list or placebo control groups.

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Background: 

Neuropathic pain is thought to arise from damage to the somatosensory nervous system. Its prevalence is increasing in line with many chronic disorders such as diabetes. All treatments have limited effectiveness. Given the evidence regarding psychological treatment for distress and disability in people with various chronic pain conditions, we were interested to investigate whether psychological treatments have any effects for those with chronic neuropathic pain.

Objectives: 

To assess the effects of psychological treatments on pain experience, disability, mood, and health-care use in adults with chronic neuropathic pain.

Search strategy: 

We searched for randomised controlled trials (RCTs) published in any language in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO, from database inception to March 2015.

Selection criteria: 

Full publications of RCTs on psychological interventions for neuropathic pain. Trials had to have lasted at least three months, had at least 20 participants in each arm at the end of treatment, and compared a psychological intervention with any active or inactive intervention.

Data collection and analysis: 

We used the standard methodological procedures expected by Cochrane.

Main results: 

Two small studies (enrolling a total of 105 participants) met the inclusion criteria. One was a standard cognitive behavioural treatment (CBT) programme for 61 people with pain from spinal cord injury, followed up for three months, and compared with a waiting list. The other was weekly group psychotherapy for 44 people with burning mouth syndrome, compared with a daily placebo tablet. The overall risk of bias was high in both trials.

The CBT study assessed participants for pain, disability, mood, and quality of life, with improvement in treatment and control groups. However, there was no more improvement in the treatment group than in the control for any outcome, either post-treatment or at follow-up. The group psychotherapy study only assessed pain, classifying participants by pain severity. There is a lack of evidence on the efficacy and safety of psychological interventions for people with neuropathic pain.

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