The long-term effectiveness of pain management programs : a systematic review and meta-analysis

The short-term efficacy of pain management programs (PMPs) is well established. However, their ability to demonstrate long-term benefits for people with chronic pain remains a key question for both the application and evolution of PMPs. Objective: To evaluate the long-term treatment gains of pain management program (PMP) interventions on self-efficacy, catastrophic thinking, and pain perceptions in patients with chronic pain. Methods: Electronic databases, key journals and reference lists of included studies were scrutinized for inclusion. The search process revealed a total of eleven studies for inclusion. Assessment of study quality was made based on length of follow-up period, the validity of measures used and information regarding the intervention. Results: Six studies included a 12 month follow-up, four studies included a 6 month follow-up, and a single study included a 9 month follow-up. Meta-analyses revealed treatment gains across pain perceptions are maintained at 12 months post-treatment. However, gains in self-efficacy significantly decreased at 12 months follow-up. There were significant improvements in pain-perception, self-efficacy and pain perceptions at 6 month follow-up compared to baseline. Conclusion: The review provides some support for the long-term efficacy of PMP interventions. There is a need for pragmatically designed follow-up studies to measure the long-term efficacy of PMPs on psychological variables, especially self-efficacy. Further research is warranted into the observed loss in treatment gains in self-efficacy over time; booster sessions delivered at 6 months post-treatment aimed at enhancing self-efficacy may help aid self-management of chronic pain.