Meta-analysis of psychological interventions for chronic low back pain.

The purpose of this meta-analysis of randomized controlled trials was to evaluate the efficacy of psychological interventions for adults with noncancerous chronic low back pain (CLBP). The authors updated and expanded upon prior meta-analyses by using broad definitions of CLBP and psychological intervention, a broad data search strategy, and state-of-the-art data analysis techniques. All relevant controlled clinical trials meeting the inclusion criteria were identified primarily through a computer-aided literature search. Two independent reviewers screened abstracts and articles for inclusion criteria and extracted relevant data. Cohen's d effect sizes were calculated by using a random effects model. Outcomes included pain intensity, emotional functioning, physical functioning (pain interference or pain-specific disability, health-related quality of life), participant ratings of global improvement, health care utilization, health care provider visits, pain medications, and employment/disability compensation status. A total of 205 effect sizes from 22 studies were pooled in 34 analyses. Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive-behavioral and self-regulatory treatments were specifically found to be efficacious. Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.     

Contextual conditional discriminations

Three experiments used a discriminated operant procedure to study conditional discrimination learning in rats. The first experiment showed that rats were capable of learning a biconditional discrimination in which two contexts served as conditional cues signalling the reinforcement contingencies associated with two discriminative stimuli. The discrimination was learned equally well when one discriminative stimulus signalled food, the other its absence, and when one stimulus signalled food, the other extinction plus mild footshock.

In Experiment 2 it was shown that prior training on such a conditional discrimination enhanced the subsequent context specificity of simple conditioning relative to control groups of animals for whom the prior training had not been conditional. Experiment 3 showed that a reversal of the significance of one pair of discriminative stimuli produced no spontaneous reversal in performance to a second, target, pair.

The pattern of results is best accounted for by an analysis of contextual conditional discrimination learning in terms of stimulus configurations and offers no support for the notion that rats may learn a general conditional rule or set.