Review question/objective The objective is to identify the effectiveness of peer support interventions in community-dwelling adults with chronic non-cancer pain. More specifically, the objectives are to identify: The effectiveness of peer support interventions in function, pain, quality of life, self-efficacy and health service utilization for adults with chronic non-cancer pain dwelling in the community, compared to those receiving usual care or other self-management interventions. The specific review question is therefore: Is peer support more effective than usual care or other self-management interventions in reducing pain and health service utilization, and enhancing function, self-efficacy and quality of life in community-dwelling older adults with chronic non-cancer pain? Inclusion criteria Types of participants Since chronic pain affects adults of all ages there will be no upper limit set; we will include participants aged 18 or over. Chronic pain in children is often managed differently than in adults, with specific guidelines, 11 therefore participants under 18 are outwith the scope of this review. Cancer pain is also considered outwith the scope of this review due to its specific nature and management 14 which often differs from non-cancer related causes of chronic pain. Adults who are hospitalized or living in residential care will also be excluded from this review. Peer support interventions in these settings are likely to differ greatly from those designed for community dwelling adults; the focus of this review is on interventions designed for community-dwelling adults. Types of intervention(s)/phenomena of interest The review will consider studies that evaluate any peer support intervention or any intervention that includes a defined element of peer support. Peer support interventions can be aimed at individuals or groups, therefore both will be included in this review. Interventions will include support groups or clubs, email discussion groups, telephone calls, home visits, and any other intervention that can be considered to be peer support. Peers will have knowledge of chronic pain. They may be self-selected or selected by health professionals, and will have received a moderate amount of training to deliver an intervention, in keeping with the definition presented above. 2 People with no training are considered natural lay helpers and are excluded from this review. People who have undergone extensive training are considered paraprofessionals and are likewise excluded from this review. In cases where it is not possible to determine whether the support was provided by a natural lay helper, peer or paraprofessional, studies will be included in order to minimize the risk of omitting relevant data. Types of comparator This review will consider studies that have compared peer support interventions to other self-management interventions that are not delivered by peers. These will include one-on-one or group interventions delivered by paraprofessionals or by health professionals. This review will also consider studies that have compared peer support to usual care. Since there is no one agreed definition of usual care for long term management of adults with chronic pain, any study that provides a description of usual care as their comparator will be included. There may also be studies in which the self-management intervention is the same in the experimental and comparison group, the only difference being the addition of a peer support element to the experimental group; these studies will also be considered. Types of outcomes This review will consider studies that include the following quantitative measures: function, pain, quality of life, self-efficacy and health service utilization. This is in keeping with recommendations for outcome measurement in chronic pain and self-management research, 13,16-17 therefore these measures should be available for consideration. Measures of function may be specific to the region of chronic pain, eg Roland Morris Low Back Pain Disability Questionnaire and Oswestry Low Back Pain Disability Questionnaire, or more general measures, eg Pain Disability Index. In addition to these measures of physical function, measures of emotional function will also be considered, eg scales that measure depression, anxiety and loneliness. Any measure of pain will be included, eg Visual Analogue Scale and Multidimensional Pain Inventory. Any quality of life measure will be included eg SF-36, Euroqol. Any measure of self-efficacy will be included, eg self-care of chronic pain and self-efficacy questionnaires. In addition, where self-management knowledge and skills have been measured these will likewise be considered (eg Health Education Impact Questionnaire) Any measure of health service utilization will be considered, such as emergency room and physician visits. Economic evaluation is however outwith the scope of this review. Where possible, outcomes measured with similar scales will be pooled together.