Which Interventions Enhance Pain Self-efficacy in People With Chronic Musculoskeletal Pain? A Systematic Review With Meta-analysis of Randomized Controlled Trials, Including Over 12 000 Participants

J Orthop Sports Phys Ther. 2020 Aug;50(8):418-430. doi: 10.2519/jospt.2020.9319.


Objective: To find out which interventions enhance pain self-efficacy in people with chronic musculoskeletal pain and to evaluate the reporting of interventions designed to enhance pain self-efficacy.

Design: Intervention systematic review with meta-analysis.

Literature search: PubMed, Embase, Scopus, PsycINFO, CINAHL, PEDro, and the Cochrane Central Register of Controlled Trials were searched from inception up to September 2019.

Study selection criteria: Randomized controlled trials evaluating pain self-efficacy as a primary or secondary outcome in chronic musculoskeletal pain.

Data synthesis: We used the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the risk of bias and the certainty of the evidence, respectively.

Results: Sixty randomized controlled trials were included (12 415 participants). There was a small effect of multicomponent, psychological, and exercise interventions improving pain self-efficacy at follow-ups of 0 to 3 months, a small effect of exercise and multicomponent interventions enhancing pain self-efficacy at follow-ups of 4 to 6 months, and a small effect of multicomponent interventions improving pain self-efficacy at follow-ups of 7 to 12 months. No interventions improved pain self-efficacy after 12 months. Self-management interventions did not improve pain self-efficacy at any follow-up time. Risk of bias, the nature of the control group, and the instrument to assess pain self-efficacy moderated the effects of psychological therapies at follow-ups of 7 to 12 months. The certainty of the evidence for all included interventions was low, due to serious risk of bias and indirectness. No trial reported the intervention in sufficient detail to allow full replication.

Conclusion: There was low-quality evidence of a small effect of multicomponent exercise and psychological interventions improving pain self-efficacy in people with chronic musculoskeletal pain. J Orthop Sports Phys Ther 2020;50(8):418-430. doi:10.2519/jospt.2020.9319.

Keywords: chronic pain; cognition; musculoskeletal pain; rehabilitation.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Chronic Pain / psychology*
  • Chronic Pain / therapy*
  • Cognitive Behavioral Therapy
  • Exercise Therapy
  • Humans
  • Musculoskeletal Pain / psychology*
  • Musculoskeletal Pain / therapy*
  • Randomized Controlled Trials as Topic
  • Self Efficacy*
  • Self-Management