Chronic pain (CP) is the leading cause of years lived with disability globally. Treatment within Western medicine is often multicomponent; the psychological element of treatment varies, yet the optimal conditions for effective reduction of pain-related outcomes remain unclear. This study used qualitative comparative analysis, a relatively new form of evidence synthesis in the field based on set theory to ascertain configurations of intervention components and processes of psychological treatment of chronic pain in adults that lead to more effective interventions. Data were extracted from 38 studies identified in a concurrent Cochrane review and were then subjected to qualitative comparative analysis. Two analyses were conducted: one to examine what is most effective for reducing disability and one to examine what is most effective for reducing distress. Analysis and comparison of the 10 treatments with best outcomes with the 10 treatments with poorest outcomes showed that interventions using graded exposure, graded exercise or behavioural rehearsal (exposure/activity), and interventions aiming to modify reinforcement contingencies (social/operant) reduced disability levels when either approach was applied but not both. Exposure/activity can improve distress levels when combined with cognitive restructuring, as long as social/operant methods are not included in treatment. Clinical implications of this study suggest that treatment components should not be assumed to be synergistic and provided in a single package.

中文翻译：

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慢性疼痛有效心理治疗的充分条件：定性比较分析。

慢性疼痛 (CP) 是全球造成多年残疾的主要原因。西医治疗通常是多方面的；治疗的心理因素各不相同，但有效减少疼痛相关结果的最佳条件仍不清楚。本研究使用定性比较分析，这是一种基于集合论的该领域相对较新的证据综合形式，以确定成人慢性疼痛的干预成分和心理治疗过程的配置，从而产生更有效的干预措施。数据是从同时进行的 Cochrane 综述中确定的 38 项研究中提取的，然后进行定性比较分析。进行了两项分析：一项是检查什么对减少残疾最有效，另一项是检查什么对减少痛苦最有效。对 10 种效果最好的治疗与 10 种效果最差的治疗的分析和比较表明，使用分级暴露、分级锻炼或行为排练（暴露/活动）的干预措施以及旨在改变强化意外事件（社交/操作）的干预措施降低了残疾水平当应用任一方法而不是同时应用两种方法时。只要治疗中不包括社交/操作方法，暴露/活动与认知重建相结合就可以改善痛苦水平。这项研究的临床意义表明，不应假定治疗成分具有协同作用并以单一包装提供。