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.     

Roles and Role Conflict of Women in Infertile Couples

This study explored the experience of role conflict for women in infertile couples. The infertile group consisted of 29 women who, with their husbands, were beginning an infertility program; comparison group subjects were 29 married women with no history of inability to conceive. Each subject completed self-report instruments measuring role conceptions and expectations, the experience of role conflict, and occupational commitment. Each husband also reported his role expectations for his ideal woman. Also, a semi-structured interview was conducted with each infertile subject. Compared to the control group, the infertile group's role conceptions were more traditional; they reported less role conflict of various kinds, and they showed greater occupational commitment. They did not differ significantly on degree of wife-husband role discrepancy, or on mother's occupational commitment. These findings lead to an understanding of infertility as part of an interactional system for dealing with potentially intolerable sources of role conflict.