The Role of Psychological Factors in Chronic Pain Treatment Outcomes in the Military.
Linda H Eaton, Diane M Flynn, Alana D Steffen and 1 others
PMID 36653221WHAT IT FOUND
Adding acupuncture, yoga, and chiropractic care to standard pain treatment did not improve outcomes or change psychological factors.
However, patients whose pain catastrophizing decreased or self-efficacy increased before intensive restoration had better pain results afterwards.
Key findings
01The addition of complementary and integrative health therapies (acupuncture, chiropractic, yoga, myofascial release) to standard interdisciplinary care did not significantly improve pain impact or psychological mediators compared to standard care alone.
02Changes in pain catastrophizing, self-efficacy, and patient activation during the initial 3-week treatment period significantly predicted improvements in pain impact after the subsequent functional restoration program.
03Psychological factors did not mediate the effect of the added complementary therapies on pain outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
44% of the sample had missing data for the primary outcome, requiring a complete-case analysis that may introduce bias if completers differed from non-completers. The study could not collect data on pain location, type, previous treatments, or cause of chronic pain due to limitations in the assessment tool. The CIH therapies were not tailored to specifically target the psychological mediators, and the 3-week dose may have been insufficient to produce changes in these factors. The analysis assumed that the initial 3-week period was the critical window for changing mediators, but other time points were not analyzed for mediation.
Declared interests
Declarations of conflict of interest: none. The study was supported by U.S. Government and N.I.H. grants.
The easy way to misread this
Do not conclude that psychological factors are irrelevant to treatment selection. While they did not mediate the specific effect of adding acupuncture or yoga, changes in catastrophizing and self-efficacy were strong predictors of overall pain improvement, suggesting they should be tracked and targeted regardless of the specific physical therapy modality used.