title: Meta-analysis of psychosocial interventions to reduce pain in patients with cancer.
abstract: OBJECTIVE
  Pain is one of the most common, burdensome, and feared symptoms experienced by patients with cancer. American Pain Society standards for pain management in cancer recommend both pharmacologic and psychosocial approaches. To obtain a current, stable, and comprehensive estimate of the effect of psychosocial interventions on pain-an important clinical topic-we conducted a meta-analysis of randomized controlled studies among adult patients with cancer published between 1966 and 2010.
  
  
  METHODS
  Three pairs of raters independently reviewed 1,681 abstracts, with a systematic process for reconciling disagreement, yielding 42 papers, of which 37 had sufficient data for meta-analysis. Studies were assessed for quality using a modified seven-item Physiotherapy Evidence Database (PEDro) coding scheme. Pain severity and interference were primary outcome measures.
  
  
  RESULTS
  Study participants (N = 4,199) were primarily women (66%) and white (72%). The weighted averaged effect size across studies for pain severity (38 comparisons) was 0.34 (95% CI, 0.23 to 0.46; P < .001), and the effect size for pain interference (four comparisons) was 0.40 (95% CI, 0.21 to 0.60; P < .001). Studies that monitored whether treatment was delivered as intended had larger effects than those that did not (P = .04).
  
  
  CONCLUSIONS
  Psychosocial interventions had medium-size effects on both pain severity and interference. These robust findings support the systematic implementation of quality-controlled psychosocial interventions as part of a multimodal approach to the management of pain in patients with cancer.
authors.affiliation: Comprehensive Cancer Center, ColumbiaUniversity, New York, NY, USA.
authors.forename: Sherri
authors.initials: S
authors.lastname: Sheinfeld Gorin
authors.forename: Paul
authors.initials: P
authors.lastname: Krebs
authors.forename: Hoda
authors.initials: H
authors.lastname: Badr
authors.forename: Elizabeth Amy
authors.initials: EA
authors.lastname: Janke
authors.forename: Heather S L
authors.initials: HS
authors.lastname: Jim
authors.forename: Bonnie
authors.initials: B
authors.lastname: Spring
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.forename: Mark A
authors.initials: MA
authors.lastname: Berendsen
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001676:Biofeedback, Psychology; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D006990:Hypnosis; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000523:psychology; D010146:Pain / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology*; D059408:Pain Management / Q000379:methods / Q000523:psychology; D010147:Pain Measurement; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D012064:Relaxation Therapy; D012720:Severity of Illness Index; D012944:Social Support; D016896:Treatment Outcome