Abstract
Anxiety, depressive symptoms and stress have a significant influence on chronic musculoskeletal pain. Behavioral modification techniques have proven to be effective to manage these variables; however, the COVID-19 pandemic has highlighted the need for an alternative to face-to-face treatment. We conducted a search of PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, APA PsychInfo, and Psychological and Behavioural Collections. The aim was to assess the effectiveness of telematic behavioral modification techniques (e-BMT) on psychological variables in patients with chronic musculoskeletal pain through a systematic review with meta-analysis. We used a conventional pairwise meta-analysis and a random-effects model. We calculated the standardized mean difference (SMD) with the corresponding 95% confidence interval (CI). Forty-one randomized controlled trials were included, with a total of 5018 participants. We found a statistically significant small effect size in favor of e-BMT in depressive symptoms (n = 3531; SMD = −0.35; 95% CI −0.46, −0.24) and anxiety (n = 2578; SMD = −0.32; 95% CI −0.42, −0.21) with low to moderate strength of evidence. However, there was no statistically significant effect on stress symptoms with moderate strength of evidence. In conclusion, e-BMT is an effective option for the management of anxiety and depressive symptoms in patients with chronic musculoskeletal pain. However, it does not seem effective to improve stress symptoms.
Highlights
We manually checked the references of the studies included in the review and checked the studies included in systematic reviews related to this topic
The estimated standardized mean difference (SMD) were interpreted as described by Hopkins et al [26]; that is, we considered an SMD of 4.0 to represent an extremely large clinical effect, 2.0–4.0 represented a very large effect, 1.2–2.0 represented a large effect, 0.6–1.2 represented a moderate effect, 0.2–0.6 represented a small effect, and
We found a statistically significant small effect size (21 RCTs; n = 2578; SMD = −0.32; 95% confidence interval (CI) −0.42, −0.21) of effectiveness of telematic behavioral modification techniques (e-behavioral modification techniques (BMT)) on anxiety compared with usual care or waiting list, with significant heterogeneity (Q = 33.47 (p = 0.04); I2 = 37% (0%, 63%); prediction interval (PI)
Summary
The COVID-19 pandemic has shaken our lives and jeopardized the treatment of countless patients with chronic pain [1,2]. Chronic pain patients have shown a significant increase in their perceived pain in comparison with the pre-pandemic period [3], as well as an increase in depressive symptoms, anxiety, loneliness, tiredness and catastrophizing [3]. Half of a sample of 2423 chronic pain patients had moderate to severe psychological distress [4]. The worsening of mental health in patients with chronic pain is not without consequences; these variables have been linked to higher pain catastrophizing, pain-related fear and avoidance, and a higher risk of misuse of opioids [5,6].
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