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.     

Epistemic constraints on practical normativity

What is the relation between what we ought to do, on the one hand, and our epistemic access to the ought-giving facts, on the other? In assessing this, it is common to distinguish ‘objective’ from ‘subjective’ oughts. Very roughly, on the objectivist conception what an agent ought to do is determined by ought-giving facts in such a way that does not depend on the agent’s beliefs about, or epistemic access to, those facts; whereas on the subjectivist conception, what an agent ought to do depends on his beliefs. This paper defends the need for, and explicates, a third category of ‘ought’: ‘warranted oughts’. Section 1 introduces the distinction between objective and subjective ‘oughts’. Sections 2–3 draw attention to some serious problems with each. Section 4 examines, though rejects, a recent attempt to replace subjective ‘oughts’ with objective ‘wide-scope oughts’ operating on belief-action combinations. Section 5 explicates the notion of a warranted ‘ought’ and defends the account against some possible objections. The resulting a picture is one in which an adequate analysis of practical normativity requires both objective and warranted ‘oughts’. Section 6 concludes by responding to a worry about countenancing both.