Quality Assessment of Randomized Control Trials Applied Psychotherapy for Chronic Pains in Iran: A Systematic Review of Domestic Trials
Identifieur interne : 000352 ( Pmc/Corpus ); précédent : 000351; suivant : 000353Quality Assessment of Randomized Control Trials Applied Psychotherapy for Chronic Pains in Iran: A Systematic Review of Domestic Trials
Auteurs : Fakhrudin Faizi ; Abbas Tavallaee ; Aboulfazl Rahimi ; Amin Saburi ; Masoud SaghafiniaSource :
- Iranian Red Crescent Medical Journal [ 2074-1804 ] ; 2014.
Abstract
Keeping in mind the burden of psychotherapy can play a crucial role concerning chronic pain (CP). Psychotherapy techniques are widely used to relief Chronic Pain (CP) worldwide. Appling psychotherapy needs to consider both individual and popular cultures. In addition to international requirements; nation-wide legitimacy should be regarded too. Psychological methods have provided a lot of articles in Iran, but they were neglected by the reviewers because the documents only have abstracts in English. The current study aimed to assess all Farsi Randomized Control Trials (RCTs) addressing psychotherapy to relieve chronic pains.
Six nation-wide medical databases were investigated in 2012 using the keyword chronic pain in the Abstracts, systematically. Appling PICO question format (patient problem or population, intervention, comparison, and outcomes) all the interventional studies were reviewed for eligibility. Retrieving full text (in Farsi) and making the articles indistinguishable, two native reviewers assessed the quality of the articles independently using Jadad scale.
Inclusion criteria met 1542 abstracts. After refining and excluding, seventeen experimental studies were retrieved and evaluated. Mean quality score of Jadad was 1.53 ± 1.37 (median = 1.0). Cognitive Behavior Therapy (CBT) was the dominant approach (11 out of 17) and the majority (6 out of 17 studies) of the treated cases was Low Back Pain (LBP). Patient-therapist gender adjustment has clearly reported in most of the studies, based on the requirements.
Cognitive Behavior Therapy was more effective than the other psychotherapy approaches relieving chronic pain in the studies. Well-designed studies and comprehensive clarification of the studies demonstrating groups, intervention, follow-up and drop outs can improve the quality of the RCTs.
Url:
DOI: 10.5812/ircmj.15312
PubMed: 25593723
PubMed Central: 4270656
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PMC:4270656Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Quality Assessment of Randomized Control Trials Applied Psychotherapy for Chronic Pains in Iran: A Systematic Review of Domestic Trials</title><author><name sortKey="Faizi, Fakhrudin" sort="Faizi, Fakhrudin" uniqKey="Faizi F" first="Fakhrudin" last="Faizi">Fakhrudin Faizi</name><affiliation><nlm:aff id="aff42685">Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Tavallaee, Abbas" sort="Tavallaee, Abbas" uniqKey="Tavallaee A" first="Abbas" last="Tavallaee">Abbas Tavallaee</name><affiliation><nlm:aff id="aff42685">Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Rahimi, Aboulfazl" sort="Rahimi, Aboulfazl" uniqKey="Rahimi A" first="Aboulfazl" last="Rahimi">Aboulfazl Rahimi</name><affiliation><nlm:aff id="aff42687">Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Saburi, Amin" sort="Saburi, Amin" uniqKey="Saburi A" first="Amin" last="Saburi">Amin Saburi</name><affiliation><nlm:aff id="aff42688">Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Saghafinia, Masoud" sort="Saghafinia, Masoud" uniqKey="Saghafinia M" first="Masoud" last="Saghafinia">Masoud Saghafinia</name><affiliation><nlm:aff id="aff42689">Trauma Research Center, Department of Anesthesia, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25593723</idno><idno type="pmc">4270656</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270656</idno><idno type="RBID">PMC:4270656</idno><idno type="doi">10.5812/ircmj.15312</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000352</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000352</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Quality Assessment of Randomized Control Trials Applied Psychotherapy for Chronic Pains in Iran: A Systematic Review of Domestic Trials</title><author><name sortKey="Faizi, Fakhrudin" sort="Faizi, Fakhrudin" uniqKey="Faizi F" first="Fakhrudin" last="Faizi">Fakhrudin Faizi</name><affiliation><nlm:aff id="aff42685">Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Tavallaee, Abbas" sort="Tavallaee, Abbas" uniqKey="Tavallaee A" first="Abbas" last="Tavallaee">Abbas Tavallaee</name><affiliation><nlm:aff id="aff42685">Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Rahimi, Aboulfazl" sort="Rahimi, Aboulfazl" uniqKey="Rahimi A" first="Aboulfazl" last="Rahimi">Aboulfazl Rahimi</name><affiliation><nlm:aff id="aff42687">Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Saburi, Amin" sort="Saburi, Amin" uniqKey="Saburi A" first="Amin" last="Saburi">Amin Saburi</name><affiliation><nlm:aff id="aff42688">Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Saghafinia, Masoud" sort="Saghafinia, Masoud" uniqKey="Saghafinia M" first="Masoud" last="Saghafinia">Masoud Saghafinia</name><affiliation><nlm:aff id="aff42689">Trauma Research Center, Department of Anesthesia, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author></analytic><series><title level="j">Iranian Red Crescent Medical Journal</title><idno type="ISSN">2074-1804</idno><idno type="eISSN">2074-1812</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Context:</title><p>Keeping in mind the burden of psychotherapy can play a crucial role concerning chronic pain (CP). Psychotherapy techniques are widely used to relief Chronic Pain (CP) worldwide. Appling psychotherapy needs to consider both individual and popular cultures. In addition to international requirements; nation-wide legitimacy should be regarded too. Psychological methods have provided a lot of articles in Iran, but they were neglected by the reviewers because the documents only have abstracts in English. The current study aimed to assess all Farsi Randomized Control Trials (RCTs) addressing psychotherapy to relieve chronic pains.</p></sec><sec><title>Evidence Acquisition:</title><p>Six nation-wide medical databases were investigated in 2012 using the keyword chronic pain in the Abstracts, systematically. Appling PICO question format (patient problem or population, intervention, comparison, and outcomes) all the interventional studies were reviewed for eligibility. Retrieving full text (in Farsi) and making the articles indistinguishable, two native reviewers assessed the quality of the articles independently using Jadad scale.</p></sec><sec><title>Results:</title><p>Inclusion criteria met 1542 abstracts. After refining and excluding, seventeen experimental studies were retrieved and evaluated. Mean quality score of Jadad was 1.53 ± 1.37 (median = 1.0). Cognitive Behavior Therapy (CBT) was the dominant approach (11 out of 17) and the majority (6 out of 17 studies) of the treated cases was Low Back Pain (LBP). Patient-therapist gender adjustment has clearly reported in most of the studies, based on the requirements.</p></sec><sec><title>Conclusions:</title><p>Cognitive Behavior Therapy was more effective than the other psychotherapy approaches relieving chronic pain in the studies. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Iran Red Crescent Med J</journal-id><journal-id journal-id-type="iso-abbrev">Iran Red Crescent Med J</journal-id><journal-id journal-id-type="doi">10.5812/ircmj</journal-id><journal-id journal-id-type="publisher-id">Kowsar</journal-id><journal-title-group><journal-title>Iranian Red Crescent Medical Journal</journal-title></journal-title-group><issn pub-type="ppub">2074-1804</issn><issn pub-type="epub">2074-1812</issn><publisher><publisher-name>Kowsar</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25593723</article-id><article-id pub-id-type="pmc">4270656</article-id><article-id pub-id-type="doi">10.5812/ircmj.15312</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title>Quality Assessment of Randomized Control Trials Applied Psychotherapy for Chronic Pains in Iran: A Systematic Review of Domestic Trials</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Faizi</surname><given-names>Fakhrudin</given-names></name><xref ref-type="aff" rid="aff42685">1</xref></contrib><contrib contrib-type="author"><name><surname>Tavallaee</surname><given-names>Abbas</given-names></name><xref ref-type="aff" rid="aff42685">1</xref><xref ref-type="corresp" rid="cor42686">*</xref></contrib><contrib contrib-type="author"><name><surname>Rahimi</surname><given-names>Aboulfazl</given-names></name><xref ref-type="aff" rid="aff42687">2</xref></contrib><contrib contrib-type="author"><name><surname>Saburi</surname><given-names>Amin</given-names></name><xref ref-type="aff" rid="aff42688">3</xref></contrib><contrib contrib-type="author"><name><surname>Saghafinia</surname><given-names>Masoud</given-names></name><xref ref-type="aff" rid="aff42689">4</xref></contrib></contrib-group><aff id="aff42685"><label>1</label>Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</aff><aff id="aff42687"><label>2</label>Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</aff><aff id="aff42688"><label>3</label>Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</aff><aff id="aff42689"><label>4</label>Trauma Research Center, Department of Anesthesia, Baqiyatallah University of Medical Sciences, Tehran, IR Iran</aff><author-notes><corresp id="cor42686"><label>*</label>Corresponding Author: Abbas Tavallaee, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188053768, E-mail: <email>tavresearch@gmail.com</email></corresp></author-notes><pub-date pub-type="epub"><day>05</day><month>9</month><year>2014</year></pub-date><pub-date pub-type="collection"><month>9</month><year>2014</year></pub-date><volume>16</volume><issue>9</issue><elocation-id>e15312</elocation-id><history><date date-type="received"><day>07</day><month>10</month><year>2013</year></date><date date-type="accepted"><day>08</day><month>1</month><year>2014</year></date><date date-type="rev-recd"><day>07</day><month>4</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2014, Iranian Red Crescent Medical Journal; Published by Kowsar.</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Context:</title><p>Keeping in mind the burden of psychotherapy can play a crucial role concerning chronic pain (CP). Psychotherapy techniques are widely used to relief Chronic Pain (CP) worldwide. Appling psychotherapy needs to consider both individual and popular cultures. In addition to international requirements; nation-wide legitimacy should be regarded too. Psychological methods have provided a lot of articles in Iran, but they were neglected by the reviewers because the documents only have abstracts in English. The current study aimed to assess all Farsi Randomized Control Trials (RCTs) addressing psychotherapy to relieve chronic pains.</p></sec><sec><title>Evidence Acquisition:</title><p>Six nation-wide medical databases were investigated in 2012 using the keyword chronic pain in the Abstracts, systematically. Appling PICO question format (patient problem or population, intervention, comparison, and outcomes) all the interventional studies were reviewed for eligibility. Retrieving full text (in Farsi) and making the articles indistinguishable, two native reviewers assessed the quality of the articles independently using Jadad scale.</p></sec><sec><title>Results:</title><p>Inclusion criteria met 1542 abstracts. After refining and excluding, seventeen experimental studies were retrieved and evaluated. Mean quality score of Jadad was 1.53 ± 1.37 (median = 1.0). Cognitive Behavior Therapy (CBT) was the dominant approach (11 out of 17) and the majority (6 out of 17 studies) of the treated cases was Low Back Pain (LBP). Patient-therapist gender adjustment has clearly reported in most of the studies, based on the requirements.</p></sec><sec><title>Conclusions:</title><p>Cognitive Behavior Therapy was more effective than the other psychotherapy approaches relieving chronic pain in the studies. Well-designed studies and comprehensive clarification of the studies demonstrating groups, intervention, follow-up and drop outs can improve the quality of the RCTs.</p></sec></abstract><kwd-group kwd-group-type="author"><kwd>Psychotherapy</kwd><kwd>Chronic Pain</kwd><kwd>Quality Assessment</kwd></kwd-group></article-meta></front><body><sec id="sec68175"><title>1. Context</title><p>Intolerable burden of Chronic Pain (CP) in the machinery-living today (<xref rid="A15312R1" ref-type="bibr">1</xref>-<xref rid="A15312R3" ref-type="bibr">3</xref>), can be diminished. Psychotherapy methods can play a crucial role in management of chronic conditions. Nowadays; psychotherapy techniques are widely used to relieve all types of chronic pains worldwide (<xref rid="A15312R4" ref-type="bibr">4</xref>, <xref rid="A15312R5" ref-type="bibr">5</xref>). Choosing appropriate techniques of psychotherapy not only depends on the client’s condition, but also on the individual and popular culture (<xref rid="A15312R6" ref-type="bibr">6</xref>). Besides international requirements, some countries have adopted nation-wide Codes and legitimacies that should be regarded in treatment setting. Many of psychotherapy methods are being used in Iran, and a lot of articles addressing psychotherapy have reported in local journals. However; the articles were neglected by the reviewers because the documents only have abstracts in English without providing full text. The non-commercially published papers usually contain useful information for health promotion (<xref rid="A15312R7" ref-type="bibr">7</xref>). However access to the raw resource is challenging but useful and innovative (<xref rid="A15312R8" ref-type="bibr">8</xref>). The number of the articles is growing considerably.</p><p>In the past decade (2002-2012); Iranian publications in the international journals have dramatically increased. Searching Pubmed database using Iran keyword in the [Tittle/Abstract] obviously reveals a twelve fold increase (1195.42%) i.e. 393 records from 1993 to 2002 has risen to 4698 at the end of years 2003-2012. Meanwhile, national databases have been developed to publish the research documents. Gathering, analyzing and assessing quality of the RCTs and reporting the culture-bound results may help sharing experiences with the other researchers.</p></sec><sec id="sec68177"><title>2. Evidence Acquisition</title><p>A systematic review for the year 2012 was conducted using keywords of chronic pain and /or its Farsi keywords in the Abstract through the main national scientific and medical databases named Magiran (http://www.magiran.com), Iranmedex (http://www.irmedex.barakatkns.com/index.asp), Scientific Information Database (www.SID.ir), Irandoc (http://www.irandoc.ac.ir), Medlib (http://medlib.ir), and Yektaweb (http://yektaweb.com). After checking for duplication, all the abstracts concerning psychotherapy solely or in combination with the other treatment regiments for chronic pain were assessed using PICO format (Population, Intervention, Comparison, Outcome) (<xref rid="A15312R9" ref-type="bibr">9</xref>). Observational studies and /or publications in the world-wide data bases were excluded. The process of searching, selecting, and recruiting the studies are shown in <xref ref-type="fig" rid="fig13234">Figure 1</xref>. Authors’ names, their affiliations, and the journal names were omitted. Peer-review process started and quality assessment of all retrieved full text articles in Farsi were examined independently by two reviewers using Jadad Scale as a reliable, valid, and specific scale in pain studies (<xref rid="A15312R10" ref-type="bibr">10</xref>). The scale rates the quality of studies in the range of zero to five. Randomization, blindness and withdrawals/dropouts each were allocated one point and then, two additional points were added if the described randomization and dropout manner were appropriate. In case of discrepancy, the agreement was appointed by the third reviewer. Applied psychotherapy and the protocol are briefly presented in <xref ref-type="table" rid="tbl17390">Table 1</xref>.</p><table-wrap id="tbl17390" orientation="portrait" position="float"><label>Table 1.</label><caption><title> Applied Protocol of Psychotherapy for Chronic Pain <sup><xref ref-type="table-fn" rid="fn14301">a</xref></sup></title></caption><table frame="hsides" rules="groups"><thead><tr><th style="text-align: left;" rowspan="1" colspan="1">Reference</th><th rowspan="1" colspan="1">Protocols for Chronic Pain</th></tr></thead><tbody><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Pouladi et al. (<xref rid="A15312R11" ref-type="bibr">11</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">PMR<sup><xref ref-type="table-fn" rid="fn14302">b</xref></sup>, Stimulus control<sup><xref ref-type="table-fn" rid="fn14303">c</xref></sup> and Stress Inoculation<sup><xref ref-type="table-fn" rid="fn14304">d</xref></sup>: 45-60 minutes for eight sessions.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Khanzadeh et al. (<xref rid="A15312R12" ref-type="bibr">12</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">Massage + exercise: 60 minutes three times a week for eight weeks (total = 24 × 60 minutes)</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Khezri et al. (<xref rid="A15312R13" ref-type="bibr">13</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">Hypnotism 60 minutes for nine sessions</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Akbari and Forough (<xref rid="A15312R14" ref-type="bibr">14</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">APS: warm pad 20 minutes, APS 16 min then activity up to tolerance; TENS: warm pad 20 min, TENS 16 minutes, and activity up to tolerance for 10 sessions.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Rafiee et al. (<xref rid="A15312R15" ref-type="bibr">15</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">CBT: 50 minutes for eight sessions, follow-up to one month.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Shaban et al. (<xref rid="A15312R16" ref-type="bibr">16</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">PMR: 30 minutes for three days, Music therapy: 30 min for three days</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Abbasi et al. (<xref rid="A15312R17" ref-type="bibr">17</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">Spouse-Assisted educational Package and or patient-oriented education (without spouse support): two hours per a week for seven sequential weeks.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Mohammadi et al. (<xref rid="A15312R18" ref-type="bibr">18</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">Mindfulness-based Cognitive therapy: two hours in a week for two month.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Rahimian (<xref rid="A15312R19" ref-type="bibr">19</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">CBGT: 90 minutes per a week for eight sequential weeks. Follow-up to four months.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Golchin et al. (<xref rid="A15312R20" ref-type="bibr">20</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">CBT: 90 minutes per a week for twelve sequential weeks.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Nadjafi Ghezeljeh et al. (<xref rid="A15312R21" ref-type="bibr">21</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">Massage: 10 minutes (five minutes for each foot) for three consecutive days.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Yousefi Nejad et al. (<xref rid="A15312R22" ref-type="bibr">22</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">Music therapy: for three days and then pain intensity measuring.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Gharaie et al. (<xref rid="A15312R23" ref-type="bibr">23</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">ACT: 60 minutes a week for eight consecutive sessions.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Sadoughi et al. (<xref rid="A15312R24" ref-type="bibr">24</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">CBT (Stress Management Training) then apprising headache in frequency, severity and duration using Headache Diary).</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Alavi et al. (<xref rid="A15312R25" ref-type="bibr">25</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">Hypnotism: three to seven sessions and then follow-up for three months.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Momen et al. (<xref rid="A15312R26" ref-type="bibr">26</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">PMR: two times (10 minutes) a day for a month and then follow-up for two months.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Vakili et al. (<xref rid="A15312R27" ref-type="bibr">27</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">CBPMT: 8 sessions in eight consecutive weeks and follow-up for two months.</td></tr></tbody></table><table-wrap-foot><fn id="fn14301"><p><sup>a</sup> Abbreviations: ACT, acceptance and commitment therapy; APS, action potential stimulation; CBT, cognitive behavior therapy; CBGT, cognitive-behavioral group therapy; CBT, cognitive behavior therapy; CBPMT, cognitive behavior pain management therapy; PMR, progressive muscle relaxation.</p></fn><fn id="fn14302"><p><sup>b</sup> Jacobson (1962).</p></fn><fn id="fn14303"><p><sup>c</sup> Kanfer (1985).</p></fn><fn id="fn14304"><p><sup>d</sup> Michenbaum & Turk (1976).</p></fn></table-wrap-foot></table-wrap></sec><sec id="sec68178"><title>3. Results</title><p>A total of 17 experimental studies out of 1542 (treating 829 patients) were retrieved out of which eleven had pretest-posttest (six with controls), four parallel, and two cross-over designs. Only one study obtained full points (five score). Mean score of Jadad was 1.53 ± 1.37 (median = 1.0). Details of quality assessment of the RCTs are summarized in <xref ref-type="table" rid="tbl17391">Table 2</xref>. There were six studies on Low Back Pain, the majority, four studies on Tension Headache (TH), four Musculoskeletal pain (MSP), and one cancer pain. Cognitive Behavior Therapy (CBT) had been applied in 11 out of 17 studies in patients with different conditions as LBP (four studies), MSP (four studies), TH (two studies) and cancer pain (one study). Two studies reported music therapy and massage for cancer pain, emphasizing that foot massage was more effective in terms of increasing relaxation and lowering pain intensity (P < 0.0001). One study (<xref rid="A15312R16" ref-type="bibr">16</xref>) which had compared CBT and music therapy for cancer pain reported that PMR was more effective (P < 0.01). <xref ref-type="table" rid="tbl17392">Table 3</xref> presents more information and clarifies differences of the studies. One parallel study (<xref rid="A15312R17" ref-type="bibr">17</xref>) used combination of family therapy and interpersonal therapy for LBP named Spouse-Assisted Multidisciplinary Pain Management Program (SA-MPMP) versus Patient-Oriented Multidisciplinary Pain Management Program (P-MPMP) reported significant reduction in Kinesiophobia (patient) and lesser spouse’s negative response to activity (P = 0.05). The two methods not only significantly decreased depression, anxiety, stress, disability, and pain, but also increased marital adjustment in comparison to the baseline. Besides, the positive outcomes of the two methods, the spouse’s stress, anxiety, and depression rose as a negative outcome in SA-MPMP method. Hypnotism as a psychodynamic psychotherapy was applied in the two studies for patients with tension-type headaches (<xref rid="A15312R13" ref-type="bibr">13</xref>, <xref rid="A15312R25" ref-type="bibr">25</xref>). Despite the low quality of articles (Jadad score zero and one); both articles reported significant reduction in pain occurrence and consumption of analgesics. The notable finding was that nine studies (<xref rid="A15312R11" ref-type="bibr">11</xref>, <xref rid="A15312R27" ref-type="bibr">27</xref>) clearly reported that both the therapists and the patients were the same sex. The patient`s or therapist’s gender were not directly mentioned in the rest (eight studies). Female patients should be treated only by female therapists based on the local rules.</p><table-wrap id="tbl17391" orientation="portrait" position="float"><label>Table 2.</label><caption><title> Quality Assessment: Jadad Score for Iranian Randomized Control Trials<sup><xref ref-type="table-fn" rid="fn14305">a</xref></sup></title></caption><table frame="hsides" rules="groups"><thead><tr><th style="text-align: left; vertical-align: top" rowspan="2" colspan="1">References</th><th style="vertical-align: top; border-bottom: solid thin" colspan="2" rowspan="1">Randomization</th><th style="vertical-align: top; border-bottom: solid thin" colspan="2" rowspan="1">Double Blinding</th><th style="vertical-align: top" rowspan="2" colspan="1">Drop-Outs</th><th style="vertical-align: top" rowspan="2" colspan="1">Total Score</th></tr><tr><th style="vertical-align: top" rowspan="1" colspan="1">Randomized</th><th style="vertical-align: top" rowspan="1" colspan="1">Appropriate and Reported</th><th style="vertical-align: top" rowspan="1" colspan="1">Double-blind</th><th style="vertical-align: top" rowspan="1" colspan="1">Appropriate and Reported</th></tr></thead><tbody><tr><td rowspan="1" colspan="1"><bold>Pouladi et al. (<xref rid="A15312R11" ref-type="bibr">11</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">2</td></tr><tr><td rowspan="1" colspan="1"><bold>Khanzadeh et al. (<xref rid="A15312R12" ref-type="bibr">12</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">2</td></tr><tr><td rowspan="1" colspan="1"><bold>Khezri et al. (<xref rid="A15312R13" ref-type="bibr">13</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td></tr><tr><td rowspan="1" colspan="1"><bold>Akbari et al. (<xref rid="A15312R14" ref-type="bibr">14</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td></tr><tr><td rowspan="1" colspan="1"><bold>Rafiee et al. (<xref rid="A15312R15" ref-type="bibr">15</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td></tr><tr><td rowspan="1" colspan="1"><bold>Shaban et al. (<xref rid="A15312R16" ref-type="bibr">16</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">2</td></tr><tr><td rowspan="1" colspan="1"><bold>Abbasi et al. (<xref rid="A15312R17" ref-type="bibr">17</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">4</td></tr><tr><td rowspan="1" colspan="1"><bold>Mohammadi et al. (<xref rid="A15312R18" ref-type="bibr">18</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">1</td></tr><tr><td rowspan="1" colspan="1"><bold>Rahimian et al. (<xref rid="A15312R19" ref-type="bibr">19</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">5</td></tr><tr><td rowspan="1" colspan="1"><bold>Golchin et al. (<xref rid="A15312R20" ref-type="bibr">20</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">2</td></tr><tr><td rowspan="1" colspan="1"><bold>Nadjafi Ghezeljeh et al. (<xref rid="A15312R21" ref-type="bibr">21</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">2</td></tr><tr><td rowspan="1" colspan="1"><bold>Yousefinejad et al. (<xref rid="A15312R22" ref-type="bibr">22</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td></tr><tr><td rowspan="1" colspan="1"><bold>Gharaie et al. (<xref rid="A15312R23" ref-type="bibr">23</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">1</td></tr><tr><td rowspan="1" colspan="1"><bold>Sadoughi et al. (<xref rid="A15312R24" ref-type="bibr">24</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">1</td></tr><tr><td rowspan="1" colspan="1"><bold>Alavi et al. (<xref rid="A15312R25" ref-type="bibr">25</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td></tr><tr><td rowspan="1" colspan="1"><bold>Momen et al. (<xref rid="A15312R26" ref-type="bibr">26</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td></tr><tr><td rowspan="1" colspan="1"><bold>Vakili et al. (<xref rid="A15312R27" ref-type="bibr">27</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">1</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">0 (NR)</td><td style="text-align: center;" rowspan="1" colspan="1">2</td></tr></tbody></table><table-wrap-foot><fn id="fn14305"><p><sup>a</sup> Abbreviations: NR, not reported; NA, not appropriate.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tbl17392" orientation="portrait" position="float"><label>Table 3.</label><caption><title> Randomized Control Trials of Psychotherapy for Chronic Pain<sup><xref ref-type="table-fn" rid="fn14306">a</xref>,<xref ref-type="table-fn" rid="fn14307">b</xref></sup></title></caption><table frame="hsides" rules="groups"><thead><tr><th style="text-align: left;" rowspan="1" colspan="1">Reference</th><th rowspan="1" colspan="1">Study Design</th><th rowspan="1" colspan="1">Quality Score</th><th rowspan="1" colspan="1">Allocation, Concealment</th><th rowspan="1" colspan="1">Condition</th><th rowspan="1" colspan="1">Sex</th><th rowspan="1" colspan="1">Sample Size</th><th rowspan="1" colspan="1">Intervention(s)</th><th rowspan="1" colspan="1">Control(s)</th><th rowspan="1" colspan="1">Measurement Method(s)</th><th rowspan="1" colspan="1">Main Results</th></tr></thead><tbody><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Pouladi et al. (<xref rid="A15312R11" ref-type="bibr">11</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(2)</td><td style="text-align: center;" rowspan="1" colspan="1">No</td><td style="text-align: center;" rowspan="1" colspan="1">LBP</td><td style="text-align: center;" rowspan="1" colspan="1">Male</td><td style="text-align: center;" rowspan="1" colspan="1">100 (4 * 25)</td><td style="text-align: center;" rowspan="1" colspan="1">Cognitive therapy(Stress Inoculation), Behavior therapy(Stimulus Control), Relaxation (PMR)</td><td style="text-align: center;" rowspan="1" colspan="1">SC; Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">PBPI, PBQ, PSEQ, BDI, MPI-F</td><td style="text-align: center;" rowspan="1" colspan="1">Cognitive therapy and PMR improved pain beliefs and behaviors (P = 0.01) more than behavior therapy, Pain Self-Efficiency enhanced (P = 0.001) and depression decreased (P = 0.001) in all intervention groups in comparison to controls.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Khanzadeh et al. (<xref rid="A15312R12" ref-type="bibr">12</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(3)</td><td style="text-align: center;" rowspan="1" colspan="1">Yes</td><td style="text-align: center;" rowspan="1" colspan="1">LBP</td><td style="text-align: center;" rowspan="1" colspan="1">Male</td><td style="text-align: center;" rowspan="1" colspan="1">30 (2 * 15)</td><td style="text-align: center;" rowspan="1" colspan="1">Combined Exercise therapy, & Massage</td><td style="text-align: center;" rowspan="1" colspan="1">SC</td><td style="text-align: center;" rowspan="1" colspan="1">VAS, Physical Activity</td><td style="text-align: center;" rowspan="1" colspan="1">Pain score lowered (2.85 ± 1.8, P = 0.003) and Physical Performance improved (31.41 ± 3.14, P = 0.002)</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Khezri et al. (<xref rid="A15312R13" ref-type="bibr">13</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT (MBD)</td><td style="text-align: center;" rowspan="1" colspan="1">(0)</td><td style="text-align: center;" rowspan="1" colspan="1">No</td><td style="text-align: center;" rowspan="1" colspan="1">TH</td><td style="text-align: center;" rowspan="1" colspan="1">NR</td><td style="text-align: center;" rowspan="1" colspan="1">3</td><td style="text-align: center;" rowspan="1" colspan="1">Hypnotism</td><td style="text-align: center;" rowspan="1" colspan="1">Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">VAS, BDI</td><td style="text-align: center;" rowspan="1" colspan="1">Decreased Pain Intensity and Anxiety after intervention and after one month follow-up comparing base line.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Akbari and Forough (<xref rid="A15312R14" ref-type="bibr">14</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(1)</td><td style="text-align: center;" rowspan="1" colspan="1">No</td><td style="text-align: center;" rowspan="1" colspan="1">Osteoarthritis</td><td style="text-align: center;" rowspan="1" colspan="1">Male and Female</td><td style="text-align: center;" rowspan="1" colspan="1">32 (16 + 16)</td><td style="text-align: center;" rowspan="1" colspan="1">APS, (Female); TENS, (Male and Female)</td><td style="text-align: center;" rowspan="1" colspan="1">Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">VAS</td><td style="text-align: center;" rowspan="1" colspan="1">No significant differences between two groups. Each stage had significant improvement comparing other stages in each group (ANOVA, P < 0.05).</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Rafiee et al. (<xref rid="A15312R15" ref-type="bibr">15</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT (MBD)</td><td style="text-align: center;" rowspan="1" colspan="1">(0)</td><td style="text-align: center;" rowspan="1" colspan="1">No</td><td style="text-align: center;" rowspan="1" colspan="1">CP (MSP)</td><td style="text-align: center;" rowspan="1" colspan="1">Male and Female</td><td style="text-align: center;" rowspan="1" colspan="1">4</td><td style="text-align: center;" rowspan="1" colspan="1">CBT</td><td style="text-align: center;" rowspan="1" colspan="1">Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">VAS, BDI, PCS, CCSI</td><td style="text-align: center;" rowspan="1" colspan="1">CBT reduced depression, pain intensity, catastrophizing, and improved coping strategies in the follow up, The effects were maintained to some extent</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Shaban et al. (<xref rid="A15312R16" ref-type="bibr">16</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(2)</td><td style="text-align: center;" rowspan="1" colspan="1">yes</td><td style="text-align: center;" rowspan="1" colspan="1">Cancer pain</td><td style="text-align: center;" rowspan="1" colspan="1">Male and Female</td><td style="text-align: center;" rowspan="1" colspan="1">100 (50 + 50)</td><td style="text-align: center;" rowspan="1" colspan="1">PMR, Music therapy</td><td style="text-align: center;" rowspan="1" colspan="1">Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">VAS</td><td style="text-align: center;" rowspan="1" colspan="1">Pain ↓ significantly in both groups comparing baseline (P < 0.001). PMR was more effective than Music therapy (P < 0.016).</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Abbasi, et al. (<xref rid="A15312R17" ref-type="bibr">17</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(4)</td><td style="text-align: center;" rowspan="1" colspan="1">Yes</td><td style="text-align: center;" rowspan="1" colspan="1">LBP</td><td style="text-align: center;" rowspan="1" colspan="1">Male and Female</td><td style="text-align: center;" rowspan="1" colspan="1">24 (12 + 12)</td><td style="text-align: center;" rowspan="1" colspan="1">SA-MPMP, Vs; P-MPMP</td><td style="text-align: center;" rowspan="1" colspan="1">Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">RDQ, VAS, DASS, TSK, SRI, MAT</td><td style="text-align: center;" rowspan="1" colspan="1">SA-MPMP ↓ kinesiophobia and spouse negative response to activity comparing P-MPMP (P = 0.05). Pre and Post comparison showed significant ↓ in depression, anxiety, stress, disability, pain, and ↑ marital adjustment (patient). Increased the spouses’ stress, anxiety and depression.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Mohammadi et al. (<xref rid="A15312R18" ref-type="bibr">18</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(1)</td><td style="text-align: center;" rowspan="1" colspan="1">Yes</td><td style="text-align: center;" rowspan="1" colspan="1">CP (MSP)</td><td style="text-align: center;" rowspan="1" colspan="1">Female</td><td style="text-align: center;" rowspan="1" colspan="1">30 (2 * 15)</td><td style="text-align: center;" rowspan="1" colspan="1">MBCT</td><td style="text-align: center;" rowspan="1" colspan="1">SC, Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">GPQ, RDQ</td><td style="text-align: center;" rowspan="1" colspan="1">MBCT reduced severity of pain (P < 0.002) and lowered disability comparing controls (P < 0.00).</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Rahimian (<xref rid="A15312R19" ref-type="bibr">19</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(5)</td><td style="text-align: center;" rowspan="1" colspan="1">Yes</td><td style="text-align: center;" rowspan="1" colspan="1">LBP</td><td style="text-align: center;" rowspan="1" colspan="1">Male and Female</td><td style="text-align: center;" rowspan="1" colspan="1">35 (13 + 12) <sup><xref ref-type="table-fn" rid="fn14307">b</xref></sup></td><td style="text-align: center;" rowspan="1" colspan="1">CBGT</td><td style="text-align: center;" rowspan="1" colspan="1">Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">MPI-F</td><td style="text-align: center;" rowspan="1" colspan="1">Mean pain score ↓significantly after intervention in comparison to controls and baseline. (P < 0.03). Power of the study reported as 1 and 0.94.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Golchin et al. (<xref rid="A15312R20" ref-type="bibr">20</xref>) 111</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(2)</td><td style="text-align: center;" rowspan="1" colspan="1">NO</td><td style="text-align: center;" rowspan="1" colspan="1">CLBP</td><td style="text-align: center;" rowspan="1" colspan="1">Female</td><td style="text-align: center;" rowspan="1" colspan="1">30 (2 * 15)</td><td style="text-align: center;" rowspan="1" colspan="1">CBT</td><td style="text-align: center;" rowspan="1" colspan="1">SC, Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">QBPDS, WOC</td><td style="text-align: center;" rowspan="1" colspan="1">Scores of experimental individuals ↓significantly in all the subscales of maladaptive coping, back pain, and ↑ in all the subscales of adaptive coping compared with control group (P < 0.05).</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Nadjafi Ghezeljeh et al. (<xref rid="A15312R21" ref-type="bibr">21</xref>) 112</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">3 Group</td><td style="text-align: center;" rowspan="1" colspan="1">2)</td><td style="text-align: center;" rowspan="1" colspan="1">Chronic Pain</td><td style="text-align: center;" rowspan="1" colspan="1">Female</td><td style="text-align: center;" rowspan="1" colspan="1">75</td><td style="text-align: center;" rowspan="1" colspan="1">Foot Massage and Relaxation</td><td style="text-align: center;" rowspan="1" colspan="1">Cross-over, Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">VAS</td><td style="text-align: center;" rowspan="1" colspan="1">Significant ↑ relaxation and ↓pain intensity (p < 0.0001). There were also statistically significant differences in variables trends of change (p < 0.0001).</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Yousefi Nejad et al. (<xref rid="A15312R22" ref-type="bibr">22</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(2)</td><td style="text-align: center;" rowspan="1" colspan="1">No</td><td style="text-align: center;" rowspan="1" colspan="1">Cancer Pain</td><td style="text-align: center;" rowspan="1" colspan="1">Male and Female</td><td style="text-align: center;" rowspan="1" colspan="1">40 (2 * 20)</td><td style="text-align: center;" rowspan="1" colspan="1">Music therapy</td><td style="text-align: center;" rowspan="1" colspan="1">Cross-over, Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">VAS</td><td style="text-align: center;" rowspan="1" colspan="1">Pain in stages of pre and post-implementation of music therapy showed significant differences on the basis of variables including age, sex, duration and the type of tissue involved (a = 5%, Z = 1.645).</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Gharaie Ardekani et al. (<xref rid="A15312R23" ref-type="bibr">23</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(2)</td><td style="text-align: center;" rowspan="1" colspan="1">Yes</td><td style="text-align: center;" rowspan="1" colspan="1">TH</td><td style="text-align: center;" rowspan="1" colspan="1">Female</td><td style="text-align: center;" rowspan="1" colspan="1">30 (2 * 15)</td><td style="text-align: center;" rowspan="1" colspan="1">ACT</td><td style="text-align: center;" rowspan="1" colspan="1">SC, Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">VAS, CPAQ</td><td style="text-align: center;" rowspan="1" colspan="1">Acceptance and Commitment Therapy caused significant reduction in pain intensity (P < 0.001).</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Sadoughi et al. (<xref rid="A15312R24" ref-type="bibr">24</xref>) 115</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(1)</td><td style="text-align: center;" rowspan="1" colspan="1">Yes</td><td style="text-align: center;" rowspan="1" colspan="1">TH</td><td style="text-align: center;" rowspan="1" colspan="1">Female</td><td style="text-align: center;" rowspan="1" colspan="1">38 (18 + 20)</td><td style="text-align: center;" rowspan="1" colspan="1">CBT + Drug</td><td style="text-align: center;" rowspan="1" colspan="1">SC (Drug)</td><td style="text-align: center;" rowspan="1" colspan="1">Headache Diary</td><td style="text-align: center;" rowspan="1" colspan="1">Significant differences between experimental and control groups in the frequency (P < 0.01), intensity (P < 0.05) and duration (P < 0.001) of headache attacks.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Alavi et al. (<xref rid="A15312R25" ref-type="bibr">25</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(1)</td><td style="text-align: center;" rowspan="1" colspan="1">No</td><td style="text-align: center;" rowspan="1" colspan="1">TH</td><td style="text-align: center;" rowspan="1" colspan="1">Male and Female</td><td style="text-align: center;" rowspan="1" colspan="1">30</td><td style="text-align: center;" rowspan="1" colspan="1">Hypnotism</td><td style="text-align: center;" rowspan="1" colspan="1">Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">VAS</td><td style="text-align: center;" rowspan="1" colspan="1">Comparison to baseline; 33% reported no headache, 13% not effective and 20% alleviated. The days of treatment for analgesic ↓significantly.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Momen et al. (<xref rid="A15312R26" ref-type="bibr">26</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(0)</td><td style="text-align: center;" rowspan="1" colspan="1">Yes</td><td style="text-align: center;" rowspan="1" colspan="1">MPDS</td><td style="text-align: center;" rowspan="1" colspan="1">Male and Female</td><td style="text-align: center;" rowspan="1" colspan="1">33 (8 + 25)</td><td style="text-align: center;" rowspan="1" colspan="1">PMR</td><td style="text-align: center;" rowspan="1" colspan="1">Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">VAS</td><td style="text-align: center;" rowspan="1" colspan="1">Comparison to baseline; intensity of pain, tenderness of masticatory muscles, maximum opening of mouth with and without pain, anxiety (P < 0.001) and depression (P = 0.001) improved significantly after treatment.</td></tr><tr style="vertical-align: top"><td rowspan="1" colspan="1"><bold>Vakili et al. (<xref rid="A15312R27" ref-type="bibr">27</xref>)</bold></td><td style="text-align: center;" rowspan="1" colspan="1">RCT</td><td style="text-align: center;" rowspan="1" colspan="1">(2)</td><td style="text-align: center;" rowspan="1" colspan="1">NO</td><td style="text-align: center;" rowspan="1" colspan="1">LBP and Anxiety</td><td style="text-align: center;" rowspan="1" colspan="1">Female</td><td style="text-align: center;" rowspan="1" colspan="1">24</td><td style="text-align: center;" rowspan="1" colspan="1">CBPMT</td><td style="text-align: center;" rowspan="1" colspan="1">SC (Drug), Baseline</td><td style="text-align: center;" rowspan="1" colspan="1">SCL-90-RBDI</td><td style="text-align: center;" rowspan="1" colspan="1">Experimental group had low depression in comparison to baseline (P < 0.02) and controls (P < 0.001). They also reported lower depression than controls after two months of follow-up (P < 0.004).</td></tr></tbody></table><table-wrap-foot><fn id="fn14306"><p><sup>a</sup> Abbreviations: ACT, acceptance and commitment therapy; APS, action potential stimulation; BDI, beck depression inventory; CBGT, cognitive-behavioral group therapy; CBPMT, cognitive behavior pain management therapy; CBT, cognitive behavior therapy; CCSI, cognitive coping strategies inventory; CP, chronic pain; CPAQ, chronic pain acceptance questionnaire; DASS42, depression-anxiety-stress scale; GPQ, graded pain questionnaire; LBP, low back pain; MAT, marital adjustment scale; MBCT, mindfulness-based cognitive therapy; MBD, multiple baseline design; MPI-F, multi-dimensional pain inventory-farsi (ASGHARI MOGHADAM-2008); MPDS, myofascial pain dysfunction syndrome; MSP, musculoskeletal pain; PBPI, pain beliefs and perception inventory; PBQ, pain behavior questionnaire; PCS, pain catastrophizing scale; PMR, progressive muscle relaxation; P-MPMP, patient-oriented multidisciplinary pain management program; PSEQ, pain self-efficiency questionnaire; QBPDS, quebec back pain disability scale; QDS, quebec disability scale; RCT, randomized controlled trial; RDQ, roland-morris disability questionnaire; SA-MPMP, spouse-assisted multidisciplinary pain management program; SC, standard care, SCL90-R, symptom checklist 90-revised; SF-36, short form quality of life 36; SRI, spouse response inventory; TH, tension headache; TENS, trans electrical nerve stimulation; TSK, tampa scale for kinesiophobia; VAS, visual analog scale; WOCQ, ways of coping questionnaire.</p></fn><fn id="fn14307"><p><sup>b</sup> Intervention group divided to male (12) and female (11) due to cultural conservation.</p></fn></table-wrap-foot></table-wrap><fig id="fig13234" orientation="portrait" position="float"><label>Figure 1.</label><caption><title>Tracking and Enrollment of RCTs</title></caption><graphic xlink:href="ircmj-16-09-15312-i001"></graphic></fig></sec><sec id="sec68179"><title>4. Discussion</title><p>According to Barrett’s definition, which is: “relaxation methods include deep breathing, imagery, massage and music therapy” (<xref rid="A15312R28" ref-type="bibr">28</xref>), nine studies used the relaxation techniques one by one or thorough interdisciplinary programs. According to many documents, relaxation techniques play an incredible role in psychological therapy of chronic pain leaving muscular and vegetative stabilization along with the interruption of pain cycle (<xref rid="A15312R29" ref-type="bibr">29</xref>). Chronic LBP was the most prevalent patient condition in the review, and CBT was applied as a choice psychotherapy method but the mean score was 2.33. CBT was also the most dominant applied approach (11 out of 17) to overcome chronic pain in the review. According to Lin and Vaska, each country can use cognitive behavioral therapy approach to develop local educational programs enriching its gray literature (<xref rid="A15312R30" ref-type="bibr">30</xref>). Considering the affected psychological functioning in chronic pain such as LBP (<xref rid="A15312R31" ref-type="bibr">31</xref>), CBT has proved to be a useful approach dealing with both cognitive therapy and behavioral manipulation. One study (<xref rid="A15312R18" ref-type="bibr">18</xref>) applied mindfulness-based cognitive therapy for chronic pain and reported positive effects. The usefulness of the technique in chronic pain was mentioned before (<xref rid="A15312R32" ref-type="bibr">32</xref>) but the limitation here was that only female subjects were recruited in the pre- and post-test study. Based on Jadad Scale, every RCT should acquire at least two points to enter quality assessment (<xref rid="A15312R33" ref-type="bibr">33</xref>), regarding the low quality of the assessed articles, they had not been entered into any reviews before. It is time to mention that most of the articles in the country are provided by students or junior researchers and then edited by faculty members. Unfortunately, students may forget to comprehensively describe their research methodology leaving the reports to be categorized as low quality regarding standard quality assessment tools. In fact, any Ph.D. or M.Sc. thesis and/or research proposals should be carefully assessed before application by a Research Counsel in Deputy of Research organized in universities countrywide. The research reports can be published only if they are supervised regarding all the standards during implementation. A remarkable difference that should be mentioned here is the National Adaptation Code (Tarh-e-Intebagh) adopted in 1998. Based on the code, every treatment on a patient should be done only by a therapist with the same sex of the patient. In conclusion, all female patients should be treated by female therapists. The code has flexibility in some situations like human resource stricture. This new approach can minimize all therapeutic misconducts and improve patient-therapist relation. Same patient-same therapist proposal was recommended to improve patients' rights and protect them through legal prohibition from psychotherapeutic misconduct (<xref rid="A15312R34" ref-type="bibr">34</xref>).</p><p>Psychotherapy is applied to relieve chronic pain as a predominant technique in Iran. Therapists applied CBT as an effective technique more than the other types of psychotherapy to overcome chronic pain. The current study reflects country-wide conformity between the applied techniques and population’s culture under legitimate rules. Keeping in mind the low quality trials in the review; it is recommend that well-designed RCTs with rigorous methodology can offer better view of psychotherapy. </p></sec></body><back><ack><p>Authors wish to offer their special thanks to Dr. Khodabakhsh Ahmadi, Director of Behavioral Science Research Center, for his guidance and financial supports. 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