Table 26Osteoarthritis knee pain: psychological therapies

Author, Year, Followup, Pain Duration, Study QualityInterventionPopulationFunction and Pain OutcomesOther Outcomes

Bennell, 2016

5 and 9 months

Duration of pain: 6 years

Fair

A. Pain coping skills training (n=74):

10, 45-minute sessions over 12 weeks; consisted of pain education and cognitive and behavioral pain coping skills training

B. Exercise (n=75):

10, 25 minute sessions over 12 week; consisted of 6 strengthening exercises.

A vs. B

Age, years: 63 vs. 63

Female: 61% vs. 59%

Radiographic disease severity:

Grade 2: 45% vs. 40%

Grade 3: 28% vs. 25%

Grade 4: 27% vs. 35%

Opioid use: 4% vs. 1%

Baseline WOMAC physical function (0-68): 35.0 vs. 34.3

Baseline WOMAC pain (0-20): 8.7 vs. 8.6

Baseline pain overall (0-100): 58.7 vs. 59.1

Baseline pain with walking (0-100): 61.3 vs. 60.9

A vs. B

5 months

WOMAC physical function: 23.4 vs. 21.4, difference 2.0 (95% −2.4 to 6.4)

WOMAC pain: 6.2 vs. 6.3, difference −0.1 (95% −1.2 to 1.0)

Pain overall : 35.7 vs. 36.0, difference −0.3 (95% −9.0 to 8.4)

Pain with walking : 39.1 vs. 42.3, difference −3.2 (95% −12.4 to 6.0)

9 months

WOMAC physical function: 21.3 vs. 18.1, difference 3.2 (95% −0.6 to 7.0)

WOMAC pain: 5.8 vs. 5.4, difference 0.4 (95% −0.8 to 1.6)

Pain overall : 34.8 vs. 34.5, difference 0.3 (95% −7.8 to 8.4)

Pain with walking : 37.3 vs. 37.5, difference −0.2 (95% −9.1 to 8.7)

A vs. B

5 months

DASS21 depression scale (0-42): 4.3 vs. 5.5, difference −1.2 (95% −4.0 to 1.6)

DASS21 anxiety scale (0-42): 4.0 vs. 4.9, difference −0.6 (95% −3.0 to 1.2)

AQoL-6D (−0.04 to 1.0): 0.79 vs. 0.76, difference 0.03 (95% −0.02 to 0.09)

9 months

DASS21 depression scale: 3.5 vs. 4.9, difference −1.4 (95% −3.6 to 0.8)

DASS21 anxiety scale: 3.0 vs. 4.6, difference −1.6 (95% −3.4 to 0.2)

AQoL-6D: 0.81 vs. 0.78, difference 0.03 (95% −0.02 to 0.08)

Percent of patients using opioids: 10% (7/72) vs. 13% (9/71), 0.77 (95% 0.3 to 1.9)

Gilbert, 2018

3, 6, 12, and 24 months

Mean duration of pain:

Fair

[New trial]

A. IMPAACT Motivational Interviewing (MI) (n=76)

1 initial session (45 to 60 minutes long), and 5 additional sessions (10 to 15 minutes long)

B. No treatment (n=79)

All patients: received brief physician consultation with recommendation to increase physical activity

A vs. B

Age: 61 vs. 65

Female: 58% vs. 62%

Mean duration of Chronicity: 9.6 vs. 12.1 years

Baseline WOMAC Function (0-68): 18.0 vs. 17.4

Baseline WOMAC Pain (0-20): 5.9 vs. 5.5

A vs. B

3 months

WOMAC Function: 16.5 (95% 14.7 to 18.4) vs. 17.8 (95% CI 16.3, 19.4); difference 1.3 (95% CI −1.1 to 3.7)

WOMAC Pain: 5.2 (95% 4.6 to 5.8) vs. 6.1 (95% CI 5.6 to 6.7); difference 1.0 (95% CI 0.2 to 1.8)

6 months

WOMAC Function: 15.1 (95% 13.1 to 17.2) vs. 16.7 (95% CI 15.1 to 18.3); difference 1.6 (95% CI −1.0 to 4.2)

WOMAC Pain: 5.3 (95% 4.6 to 6.0) vs. 5.5 (95% CI 4.9 to 6.0); difference 0.18 (95% CI −0.7 to 1.1)

12 months

WOMAC Function: 13.4 (95% 11.1 to 15.7) vs. 16.6 (95% CI 14.6 to 18.6); difference 3.2 (95% CI 0.1 to 6.2)

WOMAC Pain: 4.8 (95% 4.0 to 5.5) vs. 5.7 (95% CI 5.0 to 6.4); difference 0.9 (95% CI −0.1 to 1.9)

24 months

WOMAC Function: 12.5 (95% 10.1 to 14.9) vs. 15.3 (95% CI 12.6, 18.1); difference 2.8 (95% CI −0.8 to 6.4)

WOMAC Pain: 4.0 (95% 3.2 to 4.7) vs. 4.7 (95% CI 3.8 to 5.7); difference 0.8 (95% CI −0.4 to 2.0)

A vs. B

3 months

SF-36 PCS (0-100): 46.0 (95% 44.7 to 47.3) vs. 44.7 (95% CI 43.2 to 46.2); difference 1.4 (95% CI −0.6 to 3.4)

SF-36 MCS (0-100): 54.0 (95% 52.3 to 55.6) vs. 54.6 (95% CI 52.8 to 56.4); difference −0.6 (95% CI −3.1 to 1.8)

6 months

SF-36 PCS: 45.0 (95% 43.6 to 46.5) vs. 44.8 (95% CI 43.5 to 46.2); difference 0.23 (95% CI −1.8 to 2.2)

SF-36 MCS: 54.3 (95% 52.5 to 56.1) vs. 54.1 (95% CI 52.2 to 55.9); difference 0.3 (95% CI −2.3 to 2.8)

12 months

SF-36 PCS: 46.0 (95% 44.6 to 47.5) vs. 44.3 (95% CI 42.6 to 46.0); difference 1.7 (95% CI −0.5 to 3.9)

SF-36 MCS: 54.1 (95% 51.9 to 56.2) vs. 54.7 (95% CI 52.9 to 56.4); difference −0.6 (95% CI −3.4 to 2.1)

24 months

SF-36 PCS: 45.4 (95% 43.4 to 47.5) vs. 44.7 (95% CI 42.3 to 47.0); difference 0.78 (95% CI −2.3 to 3.9)

SF-36 MCS: 54.2 (95% 52.0 to 56.3) vs. 52.8 (95% CI 50.0 to 55.6); difference 1.3 (95% CI −2.16 to 4.8)

Helminen, 2015

31.5 to 10.5 months

Duration of pain: 7.8 years

Fair

Cognitive-Behavioral Training plus usual care (n=55):

2-hour groups sessions, weekly for 6 weeks (6 sessions total); included attention diversion methods (relaxation, imagery, distraction), activity-rest cycling and pleasant activity scheduling, cognitive restructuring, and homework assignments

B. Usual Care (n=56)

A vs. B

Age: 64.5 vs. 63 years

Female: 71% vs. 68%

: 30 vs. 30 kg/m2

Bilateral knee : 33% vs. 30%

Kellgren-Lawrence grade 2: 60% vs. 61%

Duration of Chronicity: 6.6 vs. 8.9 years

Baseline WOMAC Function (0-100): 53.0 vs. 48.4

Baseline WOMAC Pain (0-100): 57.6 vs. 56.4

Baseline pain (0-10), average past week: 6.6 vs. 6.4

Baseline pain (0-10), worst past week: 8.0 vs. 7.5

Baseline pain (0-10), average 3 months: 6.8 vs. 6.6

Baseline pain (0-10), worst 3 months: 8.2 vs. 8.0

A vs. B

Post-Treatment Average (1.5 to 10.5 months)

WOMAC Function: 36.5 vs. 36.7, difference −0.3 (95% −8.3 to 7.8)

WOMAC Pain: 35.6 vs. 39.5, difference −3.9 (95% −11.8 to 4.0)

pain, average past week: 5.0 vs. 4.9, difference 0.02 (95% −0.89 to 0.93)

pain, worst over week: 6.1 vs. 5.9, difference 0.1 (95% −0.8 to 1.1)

pain, average 3 months: 5.2 vs. 5.4 difference −0.2 (95% −1.0 to 0.6)

pain, worst 3 months: 6.4 vs. 6.6, difference −0.1 (95% −0.9 to 0.7)

A vs. B

Post-Treatment Average (1.5 to 10.5 months)

WOMAC Stiffness (0-100): 46.2 vs. 49.0 difference −2.7 (95% −11.4 to 5.9)

(0−63): 5.8 vs. 5.9, difference −0.1 (95% −2.2 to 2.0)

(0−63): 8.0 vs. 7.1, difference 0.9 (95% −1.3 to 3.1)

, 15D (scale ): 0.82 vs. 0.85, difference −0.03 (95% −0.06 to 0.00)

SF-36 Physical Functioning (scale ): 48.0 vs. 49.4 difference −1.4 (95% −10.2 to 7.3)

SF-36 Role-Physical: 44.4 vs. 44.5 difference −0.09 (95% −14.4 to 14.3)

SF-36 Bodily Pain: 57.3 vs. 57.4, difference −0.1 (95% −8.0 to 7.7)

SF-36 General Health: 53.1) vs. 58.2, difference −5.0 (95% −12.3 to 2.3)

SF-36 Vitality: 62.7 vs. 67.5, difference −4.8 (95% −12.6 to 3.1)

SF-36 Social Functioning: 75.0 vs. 82.8, difference −7.8 (95% −16.4 to 0.81)

SF-36 Role-Emotional: 67.9 vs. 74.7, difference −6.7 (95% −20.2 to 6.8)

SF-36 Emotional Well-Being: 75.3 vs. 78.5, difference −3.2 (95% −9.5 to 3.1)

SF-36 Health Change: 46.6 vs. 47.4, difference −0.8 (95% −9.2 to 7.6)

O’Moore, 2018

3 months

Duration of pain:

Fair

[New trial]

A. iCBT (n=43)

B. Usual Care (n=24)

A vs. B

Age: 63 vs. 60 years

Female: 86% vs. 68%

Baseline WOMAC- (0-68): 32.3 vs. 30.0

Baseline WOMAC-Stiffness (0-8): 4.5 vs. 4.2

Baseline WOMAC-Pain (0-20): 9.9 vs. 9.4

A vs. B

3 months

WOMAC-: 24.1 vs. 30.34; difference −6.3 (95% −11.9 to −0.7), p<0.05

WOMAC-Stiffness: 3.3 vs. 4.4, difference −1.1 (95% −2.0 to −0.3), p<0.05;

WOMAC-Pain: 7.4 vs. 9.8; difference −2.34 (95% −4.2 to −0.5), p<0.05

Somers, 2012

6-12 months

Duration of pain:

Poor

A. Pain Coping Skills Training (n=60): 1-hour group sessions, weekly for 12 weeks then every other week for 12 weeks (total of 18 sessions over 24 weeks); consisted of informational lectures, problem solving, skills training, relaxation exercises, homework assignments, and feedback

B. Usual Care (n=51)

A vs. B

Age: 58 vs. 58 years

Female: 67% vs. 78%

Caucasian: 62% vs. 61%

Mean Duration of Chronicity:

Kellgren-Lawrence score (0-4): 2.5 vs. 2.3

Baseline WOMAC function subscale (0-100): 46.2 vs. 46.1

Baseline WOMAC pain subscale (0-100): 42.8 vs. 43.4

A vs. B

Post-treatment Average (6-12 months)

WOMAC function: 35.2 vs. 37.5, p=

physical disability subscale: 1.5 vs. 1.4, p=

WOMAC pain subscale: 34.5 vs. 38.0, p=

pain subscale: 4.4 vs. 4.7, p=

A vs. B

Post-treatment Average (6-12 months)

WOMAC stiffness subscale (0-100): 44.5 vs. 46.4, p=

psychological subscale (0-10): 2.6 vs. 2.5, p=

= Activities of Daily Living; = Arthritis Impact Measurement Scale; AQoL = Assessment of Quality of Life; = Beck Anxiety Inventory; = Beck Depression Inventory; = confidence interval; DASS21 = Depression, Anxiety, and Stress Scales 21 item quesitonaire; = health-related quality of life; iCBT = internet-based cognitive-behavioral therapy; = not reported; = numeric rating scale; = not statistically significant; = osteoarthritis; SF-36 MCS = Short-Form 36 Mental Component Score; SF-36 PCS = Short-Form 36 Physical Component Score; = risk ratio; = Visual Analog Scale; WOMAC = Western Ontario and McMaster Universities Osteoarthritis index

a

Unless otherwise noted, followup time is calculated from the end of the treatment period

From: Results

Cover of Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update
Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update [Internet].
Comparative Effectiveness Review, No. 227.
Skelly AC, Chou R, Dettori JR, et al.

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