A Cochrane review [Abstract] 1 included 30 studies with a total of 3 438 subjects. Operant therapy was more effective than waiting list (SMD -0.43, 95%CI -0.75 to -0.11; 3 studies, n=153) for short-term pain relief. Little or no difference existed between operant, cognitive, or combined behavioural therapy for short- to intermediate-term pain relief. Behavioural treatment was more effective than usual care for short-term pain relief (MD -5.18, 95%CI -9.79 to -0.57; 2 studies, n=330), but there were no differences in the intermediate- to long-term, or on functional status. There was little or no difference between behavioural treatment and group exercise for pain relief or depressive symptoms over the intermediate- to long-term. Adding behavioural therapy to inpatient rehabilitation was no more effective than inpatient rehabilitation alone.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).
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