The purpose of this meta-analysis of randomized controlled trials was to evaluate the efficacy of psychological interventions for adults with noncancerous chronic low back pain (CLBP). The authors updated and expanded upon prior meta-analyses by using broad definitions of CLBP and psychological intervention, a broad data search strategy, and state-of-the-art data analysis techniques. All relevant controlled clinical trials meeting the inclusion criteria were identified primarily through a computer-aided literature search. Two independent reviewers screened abstracts and articles for inclusion criteria and extracted relevant data. Cohen's d effect sizes were calculated by using a random effects model. Outcomes included pain intensity, emotional functioning, physical functioning (pain interference or pain-specific disability, health-related quality of life), participant ratings of global improvement, health care utilization, health care provider visits, pain medications, and employment/disability compensation status. A total of 205 effect sizes from 22 studies were pooled in 34 analyses. Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive-behavioral and self-regulatory treatments were specifically found to be efficacious. Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.

Participants in this study evidenced a high degree of participation and adherence, but treatment tailored to take into account participant preferences, and that employed motivational enhancement strategies, failed to increase treatment participation over and above SCBT for chronic back pain. Evidence that participation and adherence were associated with positive outcomes supports continued clinical and research efforts focusing on these therapeutic processes.

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Objectives. To describe the feasibility of using Interactive Voice Response (IVR) technology to collect daily, prospective data about pain and quality of life in a randomized clinical trial of transdermal fentanyl (TDF).Design. This article focuses on the use of IVR technology within a larger study that compared the relative efficacy of TDF to short-acting opioids for treating chronic noncancer pain. IVR allows individuals to call into a telephone system to answer questions using the telephone keypad.Participants. Forty-six participants consented to be in the study and made at least one IVR phone call. Thirty-one participants completed the study. All participants were veterans from the VA Connecticut Healthcare System, and all reported chronic pain that had previously been treated with short-acting oral opioids.Outcome Measures. Participant adherence with calling into the IVR system was assessed via frequency counts of the number of calls placed vs the number of expected calls. Participants provided data about average pain, pain interference, medication adherence and side effects, satisfaction with pain control, and sleep quality.Results. Participants who completed the study made 84.6% of the 1302 expected calls into the IVR system, and an additional 4% of missed calls were obtained through follow-up. Proportion of completed calls declined slightly across the three call-in intervals, but remained high (from 87.5% to 81.3%).Conclusions. These data suggest that IVR is an effective way to collect prospective treatment data. Detailed discussion of additional benefits and potential drawbacks to the use of IVR technology is provided.