Rehabilitation interventions for neuropathic pain: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective: Rehabilitation interventions for chronic pain typically include education, cognitive behavioural therapy, and exercise therapy, or a combination of these. A systematic review and meta-analysis of rehabilitation interventions for neuropathic pain was conducted. Design: Randomized controlled trials were identified in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and PsycINFO databases from inception up to 3 March 2022. Subjects/Patients: Adults with chronic (> 3 months) neuropathic pain. Methods: Primary outcomes were pain intensity, pain-related disability, and work participation. Secondary outcomes were quality of life, emotional strain, insomnia, and adverse outcomes, according to VAPAIN guidelines. Analyses were made post-intervention, which was defined as the assessment point immediately following the intervention or at the first-time measurement conducted after the intervention period. Results: In total, 15 studies (total population, n = 764) were incorporated. Most common interventions were cognitive behavioural programmes including acceptance and commitment therapy (n = 4), mindfulness-based interventions (n = 5), and yoga (n  =  2). Psychological interventions reduced both pain intensity (SMD –0.49, 95% CI –0.88 to –0.10) and pain-related disability (SMD –0.51, 95% CI –0.98 to –0.03), whereas other interventions had an effect on pain intensity but not on pain-related disability. Conclusion: Rehabilitation interventions, and psychological interventions in particular, seem to be of value for patients with chronic neuropathic pain.