Cognitieve gedragstherapie bij pijn bij kanker

Publicatiedatum: 12-03-2026

Uitgangsvraag

Wat is het effect van cognitieve gedragstherapie op pijn bij patiënten met kanker?

Aanbeveling

Bespreek de mogelijkheid om een CGT-behandeling voor chronische pijn te volgen in het kader van het bio-psychosociale model met patiënten waarvan de inschatting is dat ze openstaan voor psychologische interventies.

Overweeg patiënten met complexe klachten (met beperkingen in het dagelijkse leven) door te verwijzen naar multidisciplinaire pijnrevalidatie.

Overwegingen

Balans tussen gewenste en ongewenste effecten

Wanneer we specifiek naar het bewijs van de effectiviteit van cognitieve gedragstherapie (CGT) op pijn bij patiënten met kanker kijken kunnen we het volgende concluderen.

Voor het effect van cognitieve gedragstherapie (CGT) op pijnintensiteit werd geen klinisch relevant verschil gevonden tussen de CGT en controlegroepen kort na de behandeling. Er werd onvoldoende bewijs gevonden drie tot zes maanden na de behandeling met betrekking tot pijnintensiteit, waardoor daar geen uitspraak over gedaan kan worden. Voor de uitkomstmaat interferentie van pijn werden ook geen klinisch relevante verschillen gevonden tussen de groepen. Voor de overige uitkomstmaten (overall functioneren, sociaal functioneren en pijn catastroferen) werd geen of onvoldoende bewijs gevonden om conclusies te trekken op basis van de literatuur. Er is echter ook geen bewijs voor ongewenste effecten.

Opgemerkt moet worden dat het onderzoek dat zich niet specifiek gericht heeft op patiënten met kanker maar op chronische pijn in het algemeen, wel bewijs heeft gevonden voor een gunstig effect van CGT op pijn intensiteit en andere pijn-relevante uitkomsten (Gandy et al., 2022; Ploutarchou et al., 2023; Terpstra et al., 2022; Williams, 2020). Er is geen reden om te veronderstellen dat dit niet geldt voor (chronische) pijn bij patiënten met kanker. Wel kan opgemerkt worden de gunstige effecten vaak klein zijn, en klinisch relevante effecten alleen op de korte termijn worden gevonden. Daarnaast wordt CGT vaak aangeboden als onderdeel van interdisciplinaire multimodale pijn therapie (IMPT), ook wel interdisciplinaire medisch specialistische pijnrevalidatie (IMSR) genoemd. IMPT wordt vaak ingezet bij complexe pijnproblematiek of als andere therapieën niet het gewenste effect hebben gehad. Zie ook richtlijn chronische pijnrevalidatie, standpunt medisch-specialistische revalidatie (2023) en indicatiestelling chronische pijn (in ontwikkeling). Dus ondanks gebrek aan direct bewijs bij patiënten met kanker kan CGT, als monodisciplinaire behandeling of ingebed in IMPT, mogelijk ook een gunstig effect hebben op chronische pijn bij patiënten met kanker.

Kwaliteit van bewijs

De overall kwaliteit van bewijs is zeer laag voor wat betreft het toepassen van CGT specifiek voor pijn bij patiënten met kanker. Dit betekent dat we zeer onzeker zijn over het gevonden geschatte effect van de cruciale uitkomstmaten.

Er is o.a. afgewaardeerd vanwege:

Risk of Bias: methodologische beperkingen, vanwege gebrek aan geblindeerde studies.
Imprecisie: onnauwkeurigheid, vanwege kleine studiepopulaties en brede betrouwbaarheidsintervallen van het gepoolde effect die de grens van klinische relevantie doorkruisen.

Waarden en voorkeuren van patiënten (en eventueel hun naasten/verzorgers)

Er is weinig direct bewijs dat het gewenste effect (pijnreductie) op groepsniveau optreedt bij patiënten met kanker. Er is ook geen bewijs voor ongewenste effecten van CGT. Omdat het onderzoek naar CGT bij chronische pijn in het algemeen wel gunstig effecten op pijnintensiteit en andere pijn-relevante uitkomsten laat zien kan de mogelijkheid van CGT met patiënten besproken worden. Ook een interdisciplinaire pijnbehandeling kan worden overwogen voor patiënten met complexe problematiek. De voorkeur van een patiënt dient hierbij meegewogen te worden (Zorgstandaard Chronische Pijn, 2017). CGT vraagt de bereidheid tot het werken aan gedragsverandering en een actieve inzet van de patiënt gedurende een langere periode.

Kostenaspecten

De interventie (CGT) levert meerkosten ten opzichte van de controlebehandeling (geen CGT). CGT voor pijn omvat meestal 8 tot 16 sessies van een uur, gegeven door een gespecialiseerde GGZ hulpverlener. Farmacologische behandeling zal over het algemeen tot minder kosten leiden, maar mogelijk wel tot meer ongewenste effecten.

Anderzijds, als CGT bijdraagt aan een adequate pijnbehandeling bevordert dit maatschappelijke participatie en arbeids(re)integratie en voorkomt het medische overconsumptie.

Gelijkheid ((health) equity/equitable)

De interventie leidt tot een mogelijke afname van gezondheidsgelijkheid. Het eigen risico kan worden aangesproken, waardoor financiële middelen invloed hebben op de toegankelijkheid. Gezien de aard van de therapie kunnen taalbarrières en laaggeletterdheid een probleem opleveren om de therapie te ondergaan. In de meeste behandelcentra kunnen patiënten tijdens de behandelfase terecht bij de afdeling Medische Psychologie en/of gespecialiseerde onco-psychologen. Het aanbod is echter gelimiteerd, zowel qua opnamecapaciteit als de behandelintensiteit. In de fase na de behandeling is de patiënt doorgaans aangewezen op de GGZ of pijnrevalidatieklinieken. In de meeste gevallen zullen patiënten zich moeten verplaatsen om de sessies bij te wonen, wat reistijd en reiskosten met zich meebrengt, tenzij het online therapie betreft. De impact van pijn, de multidisciplinaire aanpak en de noodzaak tot een individueel beleid maken deze ongelijkheid acceptabel. Farmacologische of interventionele behandelingen zullen ook niet altijd tot de mogelijkheden behoren, waarbij CGT een alternatieve behandeling biedt om een zo goed mogelijke pijnreductie en kwaliteit van leven te bereiken.

Aanvaardbaarheid:

Ethische aanvaardbaarheid

De interventie lijkt aanvaardbaar voor de betrokkenen. Er zijn geen ethische bezwaren, mits patiënt akkoord is met deze vorm van behandeling.

Duurzaamheid

Bij de interventie spelen duurzaamheidsaspecten geen rol.

Haalbaarheid

De werkgroep voorziet belemmeringen rondom praktische, organisatorische en financiële aspecten. De interventie wordt meestal extern gegeven (in een ander centrum dan waar de behandeling plaatsvindt/heeft plaatsgevonden). Vervoer kan een probleem zijn, zeker gezien het herhalende karakter van de behandelingen. Er is tevens een doorverwijzing nodig van de huisarts of medisch specialist naar GGZ en/of revalidatiecentrum.

Rationale van de aanbeveling: weging van argumenten voor en tegen de interventies

Er is geen direct bewijs voor de effectiviteit van CGT bij pijn bij kanker. Er is echter wel bewijs voor de effectiviteit van CGT bij chronische pijn patiënten in het algemeen. Er zijn geen negatieve effecten van CGT bekend. Daarom kan toepassen van CGT met de patiënt besproken worden. Dit kan vooral zinvol zijn voor patiënten waarbij psychosociale problematiek op de voorgrond staat, en die openstaan voor psychologische interventie.

Eindoordeel:

Zwakke aanbeveling voor het bespreken van CGT als optie voor pijn bij kanker.

Onderbouwing

Achtergrond

Chronic pain is a prevalent and burdensome late consequence of cancer and its treatment. With an aging population, the prevalence of cancer is expected to rise. Together with increased cancer survivorship, cancer-related pain will affect growing numbers of people. A systematic review reported a prevalence of 66% in patients with advanced or terminal disease, 55% in patients receiving anti-cancer treatment and 39% after treatment (van den Beuken, 2016). More than one-third of these patients reported pain of moderate to severe intensity.

Although pain may severely affect quality of life, it remains undertreated. In addition to pharmacological treatment options, non-pharmacological interventions can be considered.

Pain is not only a sensory experience but also has affective and cognitive dimensions. Cognitive behavioral therapy (CBT) has been found effective for the treatment of chronic non-cancer pain. CBT may reduce pain severity and pain interference and increase functioning and wellbeing. This has been shown for individual, group-based and internet delivered CBT (Gandy et al., 2022; Ploutarchou et al., 2023; Terpstra et al., 2022; Williams et al, 2020), and extends to pain in older adults (Niknejad et al., 2018). Hence, CBT may be a valid non-pharmacological intervention to reduce the burden of pain in patients with cancer and cancer survivors. One of the mechanisms of CBT for chronic pain may be a reduction in negative thinking styles, or pain catastrophizing (Smeets et al., 2006).

Conclusies / Summary of Findings

Summary of Findings

Population: Patients with pain related to cancer (treatment)

Intervention: Cognitive behavioral therapy

Comparator: no cognitive behavioral therapy

Click here to see this table in a document

Outcome

Timeframe

Study results and measurements

Absolute effect estimates

Certainty of the evidence

(Quality of evidence)

Summary

no CBT

CBT

Pain intensity (short-term)

Measured by:

VAS and NRS
Lower better

Based on data from 193 participants in 3 studies

Low¹

Cognitive behavioral therapy may result in little to no difference in pain intensity (short-term effect) when compared no cognitive behavioral therapy in patients with pain due to cancer (treatment).

Difference: MD 0.81 lower

(CI 95% 1.30 lower - 0.31 lower)

Pain intensity (long-term)

Measured by: NRS

Scale: 1 – 11

Lower better

Based on data from 54 participants in 1 study

5.0

Mean

3.6

Mean

Very low²

The evidence is very uncertain about the effect of cognitive behavioral therapy on pain intensity (long-term effect) in patients with pain due to cancer (treatment).

Difference: MD 1.40 lower

(CI 95% 0.47 lower - 2.33 lower)

Daily life interference (short- and long-term)

No data

No GRADE

No evidence was found regarding the effect of cognitive behavioral therapy on daily life interference in patients with pain due to cancer (treatment).

Pain interference (short-term)

Based on data from 402 participants in 5 studies

Low¹

Cognitive behavioral therapy may result in little to no difference in pain interference (short-term effect) when compared no cognitive behavioral therapy in patients with pain due to cancer (treatment).

Difference: SMD 0.06 lower

(CI 95% 0.33 lower - 0.22 higher)

Pain interference (long-term)

Based on data from 217 participants in 3 studies

Low³

Cognitive behavioral therapy may result in little to no difference in pain interference (long-term effect) when compared no cognitive behavioral therapy in patients with pain due to cancer (treatment).

Difference: SMD 0.14 higher

(CI 95% 0.33 lower - 0.62 higher)

Overall functioning (short- and long-term)

No data

No GRADE

No evidence was found regarding the effect of cognitive behavioral therapy on overall functioning in patients with pain due to cancer (treatment).

Social functioning (short-term)

No data

No GRADE

No evidence was found regarding the effect of cognitive behavioral therapy on social functioning (short-term effect) in patients with pain due to cancer (treatment).

Social functioning (long-term)

Measured by: EORTC QLQ C-30

Scale: High better

Based on data from 260 participants in 1 study

Follow up 3 months

Mean

Very low⁴

The evidence is very uncertain about the effect of cognitive behavioral therapy on social functioning (long-term effect) in patients with pain due to cancer (treatment).

Difference: MD 4.00 higher

(CI 95% 1.25 lower - 9.25 higher)

Pain catastrophizing (short-term)

Based on data from 184 participants in 2 studies

Follow up: post-treatment

Since only two RCTs reported this outcome, data could not be pooled. MDs were 7.62 and 4.85, both in favor of the intervention (CBT).

Very low⁵

The evidence is very uncertain about the effect of cognitive behavioral therapy on pain catastrophizing (short-term effect) in patients with pain due to cancer (treatment).

Pain catastrophizing (long-term)

Measured by: PCS

Based on data from 54 participants in 1 study

Follow up 3 months

18.1

Mean

10.5

Mean

Very low⁴

The evidence is very uncertain about the effect of cognitive behavioral therapy on pain catastrophizing (long-term effect) in patients with pain due to cancer (treatment).

Difference: MD 7.60 lower

(CI 95% 11.56 lower - 3.64 lower)

_{^1. Risk of Bias: serious. Due to lack of blinding}

_{Imprecision: serious. Due to very small sample size.}

_{^2. Risk of Bias: serious. Due to lack of blinding}

_{Imprecision: serious. Due to overlap of the lower limit of the 95% confidence interval with the minimal clinically important difference, and due to only one study being included.}

_{^3. Risk of Bias: serious. Due to lack of blinding}

_{Imprecision: serious. Due to overlap of the lower limit of the 95% confidence interval with the minimal clinically important difference}

_{^4. Risk of Bias: serious. Due to lack of blinding}

_{Imprecision: serious. Due to overlap of the lower limit of the 95% confidence interval with the minimal clinically important difference, and due to only one study being included.}

_{^5. Risk of Bias: serious. Due to lack of blinding}
_{Imprecision: serious. Due to overlap of the lower limit of the 95% confidence interval with the minimal clinically important difference, and due to the very small sample size}

Samenvatting literatuur

Description of studies

A total of five studies were included in the analysis of the literature (one systematic review and four randomized controlled trials).

Blumenstein (2022) conducted a systematic review and meta-analysis of effectiveness of cognitive behavioral therapy in improving functional health in cancer survivors. They searched 7 electronic databases, 91 published review articles, and 4 professional websites up until 2021 for eligible randomized and non-randomized controlled trials focusing on cancer survivors. Eligibility criteria were : 1. Intervention of CBT; 2. a clinical trial with a comparison group (with or without randomization); 3. individuals of any age diagnosed with cancer; 4. assess functional outcomes; 5. be written in English; and 6. report statistical information necessary to calculate effect size. A total of 95 studies were included in the analysis. As our current analysis was focused on adult patients with pain, these additional eligibility criteria were used. This resulted in seven randomized studies.

For details concerning the seven randomized trials included in Blumenstein (2022) and the four randomized trials that were published thereafter (Burns, 2024; Hatchard, 2020; Kelleher, 2021; Shergill, 2022), we refer to table 2.

The assessment of the risk of bias is summarized in the risk of bias tables (under the tab ‘Evidence tabellen’).

Table 2. Characteristics of included studies

Study	Participants	Comparison	Follow-up	Outcome measures	Risk of bias (per outcome measure)*
RCTs included in the systematic review by Blumenstein (2022)
Johannsen (2016)	N at baseline Intervention: 67 Control: 62 Diagnosis: breast cancer (post-treatment survivors) Age, y (mean, SD) Intervention: 56.8 (10.0) Control: 56.7 (8.1) Sex Intervention: 100% F Control: 100% F	Intervention: Mindfulness-Based Cognitive Therapy (MBCT) Intervention Characteristics: The format of MBCT consisted of group sessions that occurred weekly over the course of eight weeks. MBCT was delivered in-person. The content of MBCT adhered to a manual with specific modifications to study population. Mindfulness exercises and psychoeducation, cognitive exercises for pain catastrophizing, and homework mindfulness exercises were included. Also included were cognitive therapy exercises, with particular attention to cancer-specific rumination and physical problems. Provider: MBCT was provided by a trained mindfulness instructor. Control: Waitlist or attention control	Post-treatment, 3 months, 6 months	Pain intensity (NRS)	Some concerns (all outcomes)
Johannsen (2018)	N at baseline Intervention: 67 Control: 62 Diagnosis: breast cancer (post-treatment survivors) Age, y (mean, SD) Intervention: 56.8 (10.0) Control: 56.7 (8.1) Sex Intervention: 100% F Control: 100% F	MBCT Intervention Characteristics: The format of MBCT consisted of an eight-week protocol adhering to a program outlined in the original manual (see full text for specific citation). MBCT was provided in-person. Based on the manual mentioned above, MBCT content included mindfulness exercises and psychoeducation, cognitive exercises for pain catastrophizing, and homework mindfulness exercises. Also included cognitive therapy exercises, with particular attention to cancer-specific rumination and physical problems. Provider: MBCT was provided by an experienced mindfulness instructor with training from Oxford University, receiving supervision from the center for mindfulness research and practice.	Post-treatment, 3 months, 6 months	Pain intensity (NRS), Pain catastrophizing (PCS)	High (all outcomes)
Johansson (2008)	N at baseline** Intervention 1: 134 Intervention 2: 117 Intervention 3: 104 Control: 126 Diagnosis: Multiple cancer diagnoses at multiple stages Age, y (mean, SD) Intervention 1: 64.4 (12.6) Intervention 2: 64.0 (13.2) Intervention 3: 64.6 (13.5) Control: 62.8 (13.0) Sex Intervention 1: 57%F Intervention 2: 62%F Intervention 3: 53%F Control: 57%F	Intervention: Individual Support (IS) Intervention Characteristics: The format of IS consisted of a frequency and intensity that varied based on the specific group. There was a median of three sessions of psychologist contact. IS was delivered in-person. The content of IS utilized techniques derived from cognitive behavior therapy, including relaxation techniques, identification and challenging of negative automatic thoughts and activity scheduling and daily planning. Provider: IS was provided by a project psychologist. Control: Treatment as usual or standard care	3 months, 6 months, 12 months, 24 months	Pain (EORTC QLQ C-30 subscale); Social functioning (EORTC QLQ C-30 subscale);	High (all outcomes)
Knoerl (2018)	N at baseline Intervention: 30 Control: 30 Diagnosis: Multiple cancer diagnoses and receiving ongoing treatment Age, y (mean, SD) Intervention: 58.93 (9.33) Control: 63.37 (8.36) Sex Intervention: 76.7% F Control: 73.3% F	Intervention: PROSPECT Intervention Characteristics: The format of PROSPECT consisted of a modularized form of self-guided online cognitive behavioral strategies, including ten modules. PROSPECT was delivered online, and content focused on psychoeducation, promote communication, enhance physical activity, relaxation techniques, goal setting, behavioral activation, problem solving. Provider: PROSPECT was not administered by a provider, as it was a self-help program. Control: Waitlist or attention control	4 weeks, 8 weeks	Average pain (NRS), Pain interference (PROMIS Pain Interference 4a)	Some concerns (all outcomes)
Mendoza (2017)	N at baseline Intervention: 25 Control: 30 Diagnosis: Multiple cancer diagnoses and either active treatment or post-treatment survivorship Age, y (mean, SD) Intervention and control together: 60.95 (12.2) Sex Intervention and control together: 89% F	Intervention: Valencia Model of Waking Hypnosis and Cognitive Behavioral Therapy (VMWH-CBT) Intervention Characteristics: The format of VMWH-CBT consisted of four sessions of treatment that combined training in self-hypnosis with CBT. Each session lasted about an hour. VMWH-CBT was delivered in-person. The content of VMWH-CBT centered around teaching participants to identify and restructure any unhelpful thoughts regarding their symptoms using CBT methods. Psychoeducation about pain, fatigue, and sleep problems and learned behavioral strategies to cope with them during the study to facilitate the maintenance of treatment gains. Provider: VMWH-CBT was provided by the study clinician, who was not described further. Control: Treatment as usual or standard care	Post-treatment	Pain intensity (NRS), Pain interference (PROMIS), Pain catastrophizing (PCS)	Some concerns (all outcomes)
Mosher (2016)	N at baseline Intervention: 51 Control: 55 Diagnosis: Lung cancer diagnoses and receiving ongoing treatment Age, y (mean, SD) Intervention: 63.47 (7.68) Control: 61.96 (8.20) Sex Intervention: 54.90% F Control: 50.91% F	Intervention: Telephone Symptom Management (TSM) Intervention Characteristics: The format of TSM consisted of 4 individualized sessions delivered via telephone. The content of CSM focused on session-specific material. During the four sessions, the patient and caregiver received instruction in symptom management strategies, including relaxation exercise, problem solving, cognitive restructuring, emotion-focused/self-soothing approaches, communication skills, pleasant activity scheduling, and activity pacing. Provider: TSM was provided by a social worker. Control: education/support condition	2 weeks, 6 weeks post-treatment	Pain severity (BPI-SF), Pain interference (BPI-SF)	Some concerns (all outcomes)
Penedo (2020)	N at baseline Intervention: 95 Control: 97 Diagnosis: Advanced prostate cancer Age, y (mean, SD) Intervention: 68.81 (8.54) Control: 68.87 (9.23) Sex Intervention and control together: 0% F	Intervention: Cognitive Based Stress Management (CBSM) Intervention Characteristics: The format of CBSM consisted of weekly group sessions, which each lasted approximately ninety minutes. CBSM was delivered in-person. The content of CBSM integrated cognitive-behavioral stress- and self-management skills (e.g., cognitive restructuring, with relaxation skills training to improve quality of life and reduce symptoms). CBSM included behavioral activation, such as muscle relaxation, deep breathing, imagery, and meditation. CBSM also included homework assignments. Provider: CBSM was provided by master’s- or doctoral-level therapists who completed an in-person facilitator training. Control: Health promotion: didactic presentations of both general health information and health information specifically relevant to advanced prostate cancer	6 and 12 months	Pain (short form of the McGill Pain Questionnaire)	High (all outcomes)
Additional RCTs included
Burns (2024)	N at baseline*** Intervention: 20 Control: 20 Diagnosis: Advanced gastrointestinal cancer Age, y (mean, SD) Intervention and control together: 58.6 (13) Sex Intervention and control together: 55% F	Intervention: Acceptance and commitment therapy (ACT) Intervention Characteristics: The ACT intervention included all processes of the ACT model of behavior change (i.e., acceptance, cognitive defusion, flexible attention to the present moment, self-as-context, values, and committed action). Main components were mindfulness practices and goal setting to increase values-based activities. Provider: Therapists trained in their respective interventions Control: Education/support, including supportive listening and education on resources for coping with cancer available in their medical center and community.	2 weeks, 3 months	Pain (PROMIS), pain interference (PROMIS)	Some concerns (all outcomes)
Hatchard (2020)	N at baseline Intervention: 11 Control: 10 Diagnosis: breast cancer survivors (1-year post-treatment) Age, y (mean, SD) Intervention: 48.36 (11.37) Control: 56.5 (8.11) Sex Intervention: 100% F Control: 100% F	Intervention: mindfulness-based stress reduction (MBSR) program Intervention Characteristics: The MBSR program was conducted once a week over 8 weeks with each session lasting 2.5 h. In addition, a full day session was attended during the fifth or sixth week of the program. Participants were required to attend 7 out of 9 MBSR sessions. Providers: Registered health care professionals and supervised trainees. All leaders have experience in the management of chronic pain, formal MBSR training, and at least 5 years of experience leading MBSR groups. Control: Waitlist control	3 months	Pain interference (BPI-SF)	Some concerns (all outcomes)
Kelleher (2021)	N at baseline Intervention: 14 Control: 17 Diagnosis: colorectal cancer (completed treatment) Age (mean, SD) Intervention and control together: 59.5 (10.5) Sex Intervention and control together: 38.7% F	Intervention: coping skills training (CST) Intervention Characteristics: The telephone-based CST group received five 45-60 minute sessions of a cognitive-behavioral theory-based protocol that taught cognitive and behavioral coping skills for managing colorectal cancer pain and comorbid psychological distress. The sessions included progressive muscle relaxation, problem-solving, activity-rest cycling, cognitive restructuring, guided imagery and goal-setting. Provider: therapist (not further specified) Control: Standard care. Informational pamphlets related to survivorship health and cancer center services were mailed to the patients. Topics included nutrition, physical activity, smoking and alcohol, and survivorship care.	Post-treatment and 3 months	Pain (BPI)	Some concerns (all outcomes)
Shergill (2022)	N at baseline Intervention: 49 Control: 49 Diagnosis: breast cancer survivors (1-year post-treatment) Age, y (mean, SD) Intervention: 51.3 (11.4) Control: 55.1 (9.6) Sex Intervention: 100% F Control: 100% F	Intervention: mindfulness-based stress reduction (MBSR) program Intervention Characteristics: The MBSR program was conducted once a week over 8 weeks with each session lasting 2.5 h, along with a full day (approximately 6 hours) retreat held halfway through the course on a weekend. Participants were required to attend 7 out of 9 MBSR sessions. Each session included mindfulness meditation practice, discussion about participant experience of meditation, and applications of mindfulness in daily life. In addition, the groups discussed specific themes such as stress, pain, personal attitude and values, and mindful communication. Providers: healthcare professionals (psychologists and social workers) with formal certification in MBSR and reported a minimum of 5 years of experience providing MBSR in a group format. Control: Waitlist control	2 weeks, 3 months	Pain interference (BPI-SF), Pain catastrophizing (PCS)	Some concerns (all outcomes)

_{*For further details, see risk of bias table in the appendix}
_{**Only intervention group 1 was included in the current analysis of literature, as this intervention matched our inclusion criteria the best}

_{***A group of caregiver was also included and analyzed in the study, but these were excluded from the current analysis}

Results

Since limited data were available, outcomes that were reported using another instrument or scale than the predefined ones were reported as additional data. These data were not pooled and not graded on their level of evidence, but used as supporting evidence.

Pain intensity

Post-treatment (short-term effect)

Four studies reported the short-term effects of CBT on pain intensity (Figure 1). Johannsen (2016) and Johanssen (2018) published the same data as it was the same patient population. Follow-up was post-intervention (Johanssen 2016, 2018; Mendoza, 2017) or at 4 weeks (Knoerl, 2018). All studies used an 11-point NRS. The mean difference was -0.81 (95% confidence interval (CI) -1.30 to -0.31) in favor of CBT. This difference was not clinically relevant.

_{Figure 1. Effect of CBT on pain intensity (short-term)}

_{Z: p-value of the pooled effect; df: degrees of freedom; I²: statistic heterogeneity; CI: Confidence Interval}

In addition, three reported pain intensity, although not measured on a VAS or NRS.

Burns (2024) reported pain severity two weeks after the intervention assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) measures. The intervention group had a score of 45.03 (SD 7.44) and the control group 43.31 (9.54; MD 1.72, 95% CI -2.03 to 5.47 in favor of no CBT).

Mosher (2016) reported pain severity two weeks after the intervention assessed by the Brief Pain Inventory Short Form (BPI-SF). The intervention group had a score of 2.24 (SD 2.16) and the control group 2.62 (SD 2.34; MD -0.38, 95% CI -1.24 to 0.48 in favor of CBT).

Kelleher (2021) reported pain severity post-treatment assessed by the Brief Pain Inventory Short Form (BPI-SF). The intervention group had a mean score of 3 (SD 2) and the control group 2 (SD 2; MD -1, 95% CI-0.41 to 2.41 in favor of no CBT).

These additional data do not show clinically relevant differences, with the exception of Burns (2024), and are therefore mostly in line with the pooled analysis.

3 to 6 months (long-term effect)

Only Johannsen (2016) and Johanssen (2018) measured the long-term effect of CBT on pain intensity with an NRS. Therefore data could not be pooled. At 3 months, the intervention group had a score of 3.6 (SD 2.1) and the control group 5.0 (SD 2.4; MD -1.40, 95% CI -2.33 to -0.47] in favor of CBT).

In addition, three studies reported pain intensity, although not measured on a VAS or NRS.

Burns (2024) reported pain severity 3 months after the intervention assessed by the PROMIS measures. The intervention group had a score of 48.23 (SD 8.85) and the control group 44.24 (8.60; MD 3.99, 95% CI 0.17 to 7.81). This effect was in favor of no CBT and therefore not in line with the results by Johanssen.

Kelleher (2021) reported pain severity at 3 months follow-up assessed by the Brief Pain Inventory Short Form (BPI-SF). The intervention group had a mean score of 2 (SD 2) and the control group 1 (SD 2; MD 0, 95% CI -1.15 to 1.15.

Penedo (2020) reported pain intensity on the McGill Pain Questionnaire. At 6 months, the intervention group had a score of 4.69 (SD 0.63) and the control group had a score of 5.43 (SD 0.63; MD -0.74 [-0.92, -0.56] in favor of CBT).

This result is not clinically relevant.

Daily life interference

Post-treatment (short-term effect)

Only ‘pain interference’, no other daily life interference, was reported by five studies (Figure 2). Follow-up was post-treatment (Mendoza, 2017) at 2 weeks (Mosher, 2016; Shergill, 2022; Burns, 2024) or 4 weeks (Knoerl, 2018). Instruments used were the PROMIS Pain Interference 4a (Knoerl, 2018), PROMIS (Burns, 2024; Mendoza, 2017;), or the BPI-SF (Mosher, 2016; Shergill, 2022). The pooled standardized mean difference (SMD) was -0.06 (95% CI -0.33 to 0.22) in favor of CBT. This difference was not clinically relevant.

_{Figure 2. Effect of CBT on pain interference (short-term)}

_{Z: p-value of the pooled effect; df: degrees of freedom; I²: statistic heterogeneity; CI: Confidence Interval}

3 to 6 months (long-term effect)

Again, only the outcome pain interference was reported by three studies (Figure 3). Follow-up for all three studies was three months. Instruments used were PROMIS (Burns, 2024) BPI-SF (Hatchard, 2020; Shergill, 2022). The pooled SMD was 0.14 (95% CI-0.33 to 0.62) in favor of no CBT. This difference was not clinically relevant.

_{Figure 3: Effect of CBT on pain interference (3 months)}

_{Z: p-value of the pooled effect; df: degrees of freedom; I²: statistic heterogeneity; CI: Confidence Interval}

Social functioning

Post-treatment (short-term effect)

None of the included studies reported the short-term effect of CBT on social functioning.

3 to 6 months (long-term effect)

Only Johansson (2008) assessed the long-term effect of CBT on social functioning. This was assessed by a subscale of the EORTC QLQ C-30.

At 3 months, the mean score in the intervention group was 88 (SD 20) and in the control group 84 (SD 23; MD 4.00, 95%CI -1.25 to 9.25 in favor of CBT). This difference was not considered clinically relevant.

Pain catastrophizing

Post-treatment (short-term effect)

Two studies reported pain catastrophizing post-treatment. Therefore the results could not be pooled. Pain catastrophizing was assessed on the PCS.

Johannsen (2018) reported the mean score in the intervention group was 10.7 (SD 8.19) and in the control group 18.32 (SD 10.7; MD -7.62, 95% CI -11.22 to -4.02 in favor of CBT).

Mendoza (2017) reported the mean score in the intervention group was 4.96 (SD 6.49) and the control group 9.81 (SD 9.75; MD -4.85, 95% CI -9.20 to -0.50 in favor of CBT).

3 to 6 months (long-term effect)

One study reported pain catastrophizing at 3 months. Therefore the results could not be pooled. Pain catastrophizing was assessed on the PCS.

Johannsen (2018) reported the mean score in the intervention group was 10.5 (SD 9.49) and in the control group 18.1 (SD 10.36; MD -7.60, 95% CI -11.56 to -3.64 in favor of CBT).

Zoeken en selecteren

A systematic review of the literature was performed to answer the following question:

What is the (in)effectiveness of cognitive behavioral therapy for patients with pain due to cancer (treatment)?

Table 1. PICO

Patients	Adult patients with pain due to cancer (treatment)
Intervention	Cognitive behavioral therapy
Control	No cognitive behavioral therapy (usual care)
Outcomes	Pain intensity, interference in daily life, overall functioning, social functioning, pain catastrophizing
Other selection criteria	Study design: systematic reviews and randomized controlled trials Follow-up: post-intervention and at least 3 months after

Relevant outcome measures

The guideline panel considered pain intensity as a critical outcome measure for decision making; and all other outcomes as an important outcome measure for decision making.

The guideline panel defined the outcome measures as follows:

Pain intensity: assessed Visual Analog Scale (VAS) or Numeric Rating Scale (NRS)
Interference in daily life: assessed with Brief pain inventory (BPI), PROMIS or Pain Disability Index (PDI)
Social functioning: assessed with Short Form (SF)-36 or SF-12
Pain catastrophizing: assessed with Pain Catastrophizing Scale (PCS)

A priori, the guideline panel did not define the other outcome measures listed above but used the definitions used in the studies.

The guideline panel defined the following as a minimal clinically (patient) important difference:

Pain intensity: MD <-1.5 or >1.5 on VAS/NRS

Pain interference: SMD <-0.5 or >0.5

Pain catastrophizing: MD <-8 or >8 on PCS

Social functioning: SMD <-0.5 or >0.5

Search and select (Methods)

A systematic literature search was performed by a medical information specialist using the following bibliographic databases: Embase.com and Ovid/Medline. Both databases were searched from 2016 to 2024 for systematic reviews and RCTs. Systematic searches were completed using a combination of controlled vocabulary/subject headings (e.g., Emtree-terms, MeSH) wherever they were available and natural language keywords. The overall search strategy was derived from two primary search concepts: (1) cognitive behavioral therapy; (2) pain AND cancer. Duplicates were removed using EndNote software. After deduplication a total of 533 systematic reviews and 649 RCTs were found.

Due to the large quantity, only systematic reviews were screened first for selection based on title or abstract. Initially, 16 systematic reviews were selected based on title and abstract screening. After reading the full text, 15 systematic reviews were excluded (see the exclusion table under the tab ‘Evidence tabellen’), and one systematic review was included. In addition, RCTs were screened that were published later than the search date of the included systematic review. A total of 23 RCTs were selected based on title and abstract screening. After reading the full text, 19 RCTs were excluded and four were included.

Referenties

Blumenstein KG, Brose A, Kemp C, Meister D, Walling E, DuVall AS, Zhang A. Effectiveness of cognitive behavioral therapy in improving functional health in cancer survivors: A systematic review and meta-analysis. Crit Rev Oncol Hematol. 2022 Jul;175:103709. doi: 10.1016/j.critrevonc.2022.103709. Epub 2022 May 14. PMID: 35580765.
Gandy M, Pang STY, Scott AJ, Heriseanu AI, Bisby MA, Dudeney J, Karin E, Titov N, Dear BF. Internet-delivered cognitive and behavioural based interventions for adults with chronic pain: a systematic review and meta-analysis of randomized controlled trials. Pain. 2022 Oct 1;163(10):e1041-e1053. doi: 10.1097/j.pain.0000000000002606. Epub 2022 Feb 7. PMID: 35121696.
Hatchard, T., Mioduszewski, O., Khoo, EL. et al. Reduced Emotional Reactivity in Breast Cancer Survivors with Chronic Neuropathic Pain Following Mindfulness-Based Stress Reduction (MBSR): an fMRI Pilot Investigation. Mindfulness 12, 751–762 (2021). https://doi.org/10.1007/s12671-020-01546-9.
Kelleher SA, Fisher HM, Winger JG, Somers TJ, Uronis HE, Wright AN, Keefe FJ. Feasibility, engagement, and acceptability of a behavioral pain management intervention for colorectal cancer survivors with pain and psychological distress: data from a pilot randomized controlled trial. Support Care Cancer. 2021 Sep;29(9):5361-5369. doi: 10.1007/s00520-021-06126-8. Epub 2021 Mar 8. PMID: 33686520.
Niknejad B, Bolier R, Henderson CR Jr, Delgado D, Kozlov E, Löckenhoff CE, Reid MC. Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults: A Systematic Review and Meta-analysis. JAMA Intern Med. 2018 Jun 1;178(6):830-839. doi: 10.1001/jamainternmed.2018.0756. PMID: 29801109; PMCID: PMC6145761.
Ploutarchou G, Savva C, Karagiannis C, Pavlou K, O'Sullivan K, Korakakis V. The effectiveness of cognitive behavioural therapy in chronic neck pain: A systematic review with meta-analysis. Cogn Behav Ther. 2023 Sep;52(5):523-563. doi: 10.1080/16506073.2023.2236296. Epub 2023 Jul 24. PMID: 37485605.
Shergill Y, Rice DB, Khoo EL, Jarvis V, Zhang T, Taljaard M, Wilson KG, Romanow H, Glynn B, Small R, Rash JA, Smith A, Monteiro L, Smyth C, Poulin PA. Mindfulness-Based Stress Reduction in Breast Cancer Survivors with Chronic Neuropathic Pain: A Randomized Controlled Trial. Pain Res Manag. 2022 Jul 7;2022:4020550. doi: 10.1155/2022/4020550. PMID: 35845983; PMCID: PMC9282981.
Smeets R, Vlaeyen j, Kester A, Knottnerus A. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain J Pain, 7 (2006), pp. 261-271. doi:10.1016/j.jpain.2005.10.011.
Terpstra JA, van der Vaart R, van Beugen S, van Eersel RA, Gkika I, Erdős D, Schmidt J, Radstake C, Kloppenburg M, van Middendorp H, Evers AWM. Guided internet-based cognitive-behavioral therapy for patients with chronic pain: A meta-analytic review. Internet Interv. 2022 Nov 10;30:100587. doi: 10.1016/j.invent.2022.100587. PMID: 36406977; PMCID: PMC9672957.
van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2016 Jun;51(6):1070-1090.e9. doi: 10.1016/j.jpainsymman.2015.12.340. Epub 2016 Apr 23. PMID: 27112310.
Williams_AC de C, Fisher_E, Hearn_L, Eccleston_C. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD007407. DOI: 10.1002/14651858.CD007407.pub4.

Evidence tabellen

Risk of Bias tables

Study reference

(first author, publication year)

Was the allocation sequence adequately generated?

Definitely yes

Probably yes

Probably no

Definitely no

Was the allocation adequately concealed?

Definitely yes

Probably yes

Probably no

Definitely no

Blinding: Was knowledge of the allocated

interventions adequately prevented?

Were patients blinded?

Were healthcare providers blinded?

Were data collectors blinded?

Were outcome assessors blinded?

Were data analysts blinded?

Definitely yes

Probably yes

Probably no

Definitely no

Was loss to follow-up (missing outcome data) infrequent?

Definitely yes

Probably yes

Probably no

Definitely no

Are reports of the study free of selective outcome reporting?

Definitely yes

Probably yes

Probably no

Definitely no

Was the study apparently free of other problems that could put it at a risk of bias?

Definitely yes

Probably yes

Probably no

Definitely no

Overall risk of bias

If applicable/necessary, per outcome measure

LOW

Some concerns

HIGH

Penedo 2020

Probably yes

Randomization was done by an online tool. The random allocation sequence was generated by research staff.

Unknown

Allocation concealment is not mentioned

Definitely no

Blinding was not mentioned. Assumably open-label due to the nature of the intervention

Probably no

>20% was lost to follow-up

Probably yes

No other problems noted.

HIGH

All outcomes

Johansson 2008

Definitely yes

Patients

were randomised by an independent oncologic centre (computer-generated

allocation schedule)

Unclear

Allocation concealment is not mentioned

Definitely no

Blinding was not mentioned. Assumably open-label due to the nature of the intervention.

Probably yes

Drop-out rates were reported and reasons for attrition were provided; no significant imbalance between groups.

Unclear

Outcomes are reported as per the aims, but a pre-registered protocol was not referenced to confirm completeness.

Probably yes

No other problems noted.

HIGH

All outcomes

Mosher 2016

Probably yes

The study reports using a computer-generated randomization sequence to allocate participants to groups done by an independent person.

Unclear

Allocation concealment is not mentioned

Probably no

Participants were not blinded due to the nature of the intervention. Research assistants who were blind to study

condition conducted all assessments through

telephone.

Probably yes

Drop-out rates were reported and reasons for attrition were provided; dropout was similar between groups and intention-to-treat framework was implemented

Probably yes

Outcomes were reported as described in the trial registration

Probably yes

No other problems noted.

Some concerns

All outcomes

Knoerl 2018

Probably yes

Randomization was carried out in a 1:1 ratio using a computer-generated random numbers table. Randomization

was stratified according to recruitment site to

balance out center effects. The principal investigator generated

the random allocation sequence, enrolled the

patients, and assigned participants to a study group.

Unclear

Allocation concealment is not mentioned

Probably no

Participants were not blinded due to the nature of the intervention. Blinding of outcome assessors was not mentioned.

Health care providers were not informed of their patients’ study group assignment.

Probably yes

Drop-out rates were reported and reasons for attrition were provided; dropout was similar between groups.

Probably yes

Outcomes were reported as described in the trial registration

Probably yes

No other problems noted.

Some concerns

All outcomes

Johannsen 2018

Probably yes

The statistical software Power And Sample Size (PASS)) was used for the randomization procedure.

Unclear

Allocation concealment is not mentioned

Definitely no

No blinding of study condition was

feasible due to the design of the present study (i.e., wait-list control group).

Probably no

Drop-out rates were reported and reasons for attrition were provided; The dropout rates were unbalanced between study groups, with higher dropout rates in the intervention group (31.3% (T2), 37.3% (T3), and 41.8% (T4)) compared with the waitlist control (1.6% (T2) and 8.1% (T3, T4)) The intention-to-treat framework was implemented

Probably yes

Outcomes were reported as described in the trial registration

Probably yes

No other problems noted.

HIGH

All outcomes

Mendoza 2018

Probably yes

Randomization is described, although not detailed.

Probably yes

The blocks had different sizes in different orders for each subgroup to prevent the study clinician (M.E.M.) from being able to predict the randomization order. In order to avoid unblinding the research staff who collected outcome data, the clinician prepared the materials for the condition assigned to each participant after they had consented for participation.

Probably no

No blinding of study condition was

feasible for the participant due to the design of the present study.

The primary and secondary outcome measures were administered by phone by research assistants who were blind to the study hypotheses and treatment condition

Definitely no

Drop-out rates were reported, although reasons were not. At 3 months, the dropout rate in the control group was much higher.

Unclear

Outcomes are reported as per the aims, but a pre-registered protocol was not referenced to confirm completeness

Probably yes

No other problems noted.

Some concerns

All outcomes

Burns 2024

Probably yes

Randomization was done using R software. A statistician produced a stratified block randomization scheme balanced by patient performance status (ECOG scores 0 or 1 vs. 2).

Unclear

Allocation concealment is not mentioned

Probably no

No blinding of study condition was

feasible for the participant due to the design of the present study.

Research assistants blind to study condition conducted individual phone assessments at 2 weeks and 3 months.

Unclear

The majority of patients were retained across follow-ups (81% at 2 weeks and 73% at 3 months post-intervention). Overall, 15.49% of data were missing, and nearly all attrition was due to patient death or severe medical issues. However, it is not mentioned whether this was balanced between the intervention and control group.

Definitely yes

Outcomes were reported as described in the trial registration

Probably yes

No other problems noted.

Some concerns

All outcomes

Hatchard 2020

Probably yes

Randomization was computer generated by a statistician who was not associated with the study. Participants were randomly allocated within strata to the MBSR or waitlist group using the method of optimal batch-wise minimization

Probably yes

Allocation to the groups was only known to the research coordinators and concealed from all other study members

Probably no

No blinding of study condition was

feasible for the participant due to the design of the present study.

Investigators, research assistants, neuroimaging staff, and data analysts involved in the neuroimaging study were blinded to group assignment.

Probably no

Loss to follow-up after allocation was high: 41.4% in the intervention group and 45.5% in the control group withdrew from the study before receiving the intervention. Reasons were reported.

Definitely yes

Outcomes were reported as described in the trial registration

Probably yes

No other problems noted.

Some concerns

All outcomes

Kelleher 2021

Probably yes

A random number assignment procedure

was conducted by a study member with no participant interaction.

Probably yes

Conducted by a study member with no participant interaction, therefore probably well concealed

Probably no

No blinding of study condition was

feasible for the participant due to the design of the present study. However, participants were blinded to study hypotheses and completed assessments online to reduce demand characteristics and assessor bias. Study statisticians were not involved in data collection. No further details.

Definitely yes

Ninety-four percent of participants completed the study (n=29). One participant from the control group was lost to follow-up post-treatment and another participant from the control group during 3 months follow-up.

Unclear

Outcomes are reported as per the aims, but a pre-registered protocol was not referenced to confirm completeness

Probably yes

No other problems noted.

Some concerns

All outcomes

Shergill 2022

Definitely yes

Allocations were performed by a statistician who was not associated with the study using computer-generated, stratified,

and permuted block design with randomly varying block lengths of 2, 4, or 6. Only the research coordinators

were aware of treatment assignments.

Definitely yes

Allocations were concealed from investigators, treating

physicians, statisticians, and research assistants

Probably no

No blinding of study condition was

feasible for the participant due to the design of the present study. Participants

were assessed by research assistants who had no knowledge

of group allocations and were asked explicitly to not discuss

their group allocation with the research assistants.

Probably no

Loss to follow-up was quite high: 34.7% in the intervention group and 24.5% in the control group. Reasons were reported.

Definitely yes

Outcomes were reported as described in the trial registration

Probably yes

No other problems noted.

Some concerns

All outcomes

Table of excluded studies

Reference	Reason for exclusion
Fisher HM, Winger JG, Miller SN, Wright AN, Plumb Vilardaga JC, Majestic C, Kelleher SA, Somers TJ. Relationship between social support, physical symptoms, and depression in women with breast cancer and pain. Support Care Cancer. 2021 Sep;29(9):5513-5521. doi: 10.1007/s00520-021-06136-6. Epub 2021 Mar 15. PMID: 33723675; PMCID: PMC8919209.	wrong study design
Guan NC, Beng TS, Sue-Yin L, Kanagasundram S. The Effect of 5-Min Mindful Breathing on Pain in Palliative Care Cancer Patients: A Randomized Controlled Study. Indian J Palliat Care. 2021 Jan-Mar;27(1):83-88. doi: 10.4103/IJPC.IJPC_122_20. Epub 2021 Feb 17. PMID: 34035622; PMCID: PMC8121240.	wrong intervention
Look ML, Tan SB, Hong LL, Ng CG, Yee HA, Lim LY, Ng DLC, Chai CS, Loh EC, Lam CL. Symptom reduction in palliative care from single session mindful breathing: a randomised controlled trial. BMJ Support Palliat Care. 2021 Dec;11(4):433-439. doi: 10.1136/bmjspcare-2020-002382. Epub 2020 Aug 11. PMID: 32788274.	wrong intervention
Burns MF, Secinti E, Johns SA, Wu W, Helft PR, Turk AA, Loehrer PJ Sr, Sehdev A, Al-Hader AA, Mosher CE. Impact of acceptance and commitment therapy on physical and psychological symptoms in advanced gastrointestinal cancer patients and caregivers: Secondary results of a pilot randomized trial. J Contextual Behav Sci. 2023 Jan;27:107-115. doi: 10.1016/j.jcbs.2023.01.001. Epub 2023 Jan 6. PMID: 37064761; PMCID: PMC10100868.	wrong comparator
Fisher HM, Hyland KA, Winger JG, Miller SN, Amaden GH, Diachina AK, Kelleher SA, Somers TJ. Effect of Pain Coping Skills Training on Pain and Pain Medication Use for Women With Breast Cancer. J Pain Symptom Manage. 2023 Jul;66(1):70-79. doi: 10.1016/j.jpainsymman.2023.03.012. Epub 2023 Apr 6. PMID: 37028732; PMCID: PMC10330043.	wrong population (not necessarily pain at baseline)
Mansouri A, Javedani M, Rezazadeh Yazd SA, Nikandish M, Khataei A, Atrian A, Moradi F, Moghbeli N, Seifi Z. The Efficacy of Cognitive-Behavioral Group Therapy on Depression, Anxiety, and Pain-Coping Strategies in Women With Breast Cancer. J Nerv Ment Dis. 2023 Nov 1;211(11):835-840. doi: 10.1097/NMD.0000000000001713. Epub 2023 Sep 21. PMID: 37734162.	wrong intervention
Fernández-Rodríguez C, González-Fernández S, Coto-Lesmes R, Pedrosa I. Behavioral Activation and Acceptance and Commitment Therapy in the Treatment of Anxiety and Depression in Cancer Survivors: A Randomized Clinical Trial. Behav Modif. 2021 Sep;45(5):822-859. doi: 10.1177/0145445520916441. Epub 2020 Apr 21. PMID: 32316765.	wrong population (no pain at baseline)
Eaton LH, Beck SL, Jensen MP. An Audio-Recorded Hypnosis Intervention for Chronic Pain Management in Cancer Survivors: A Randomized Controlled Pilot Study. Int J Clin Exp Hypn. 2021 Oct-Dec;69(4):422-440. doi: 10.1080/00207144.2021.1951119. Epub 2021 Jul 26. PMID: 34309480; PMCID: PMC8458244.	wrong population (not necessariyl pain at baseline)
Zheng X, Jin Q, Lu Q, Cai Q. Effects of targeted nursing interventions on cancer pain and quality of life of advanced gastric cancer patients. Int J Clin Exp Med. 2021;14(1):272-9.	wrong intervention
Fisher HM, Stalls J, Winger JG, Miller SN, Plumb Vilardaga JC, Majestic C, Kelleher SA, Somers TJ. Role of self-efficacy for pain management and pain catastrophizing in the relationship between pain severity and depressive symptoms in women with breast cancer and pain. J Psychosoc Oncol. 2023;41(1):87-103. doi: 10.1080/07347332.2022.2046676. Epub 2022 Mar 21. PMID: 35311481; PMCID: PMC9489816.	wrong study design
Nabian, P. Effectiveness of Cognitive-Behavioral Group Therapy on Depression, Anxiety, and Pain Coping Strategies in Women with Breast Cancer. European Journal of Molecular and Clinical Medicine. 2022;9(8):1995-2005.	wrong population (not necessariyl pain at baseline)
Qu L, Yin Y, Zhao N, Lv Y, Xu H. Analysis of Intervention Effect and Satisfaction of Holistic Nursing after Oral Tumor Resection. Comput Math Methods Med. 2022 Jul 15;2022:3788605. doi: 10.1155/2022/3788605. Retraction in: Comput Math Methods Med. 2023 Jul 26;2023:9840934. doi: 10.1155/2023/9840934. PMID: 35872954; PMCID: PMC9307384.	Retracted article
Rocamora González C, Rodríguez Vega B, Torrijos Zarcero M, Mediavilla R, Bouzó Molina N, Plaza Fernández R, Pascual Migueláñez I, Palao Tarrero Á. Mindfulness based intervention through mobile app for colorectal cancer people awaiting surgery: A randomized clinical trial. Cir Esp (Engl Ed). 2022 Dec;100(12):747-754. doi: 10.1016/j.cireng.2022.08.008. Epub 2022 Sep 2. PMID: 36064177.	wrong population (not necessarily pain at baseline)
Ulfig CM. Cognitive behavioral effects on emotional well-being, worry about cancer progression, proinflammatory cytokines, and cancer recurrence among women with confirmed gynecologic malignancies. University of Florida; 2020.	Not peer reviewed
Yang Y, Zhang H, Li Y, Liu Z, Liu S, Li X, Fan G, Xu Y, Wang BQ. The effectiveness of computer-assisted Cognitive Behavioral Therapy (cCBT) for psychological outcomes in patients with laryngectomy: Randomized controlled trial. J Affect Disord. 2022 Mar 1;300:59-65. doi: 10.1016/j.jad.2021.12.068. Epub 2021 Dec 21. PMID: 34942224.	wrong population (not necessarily pain at baseline)
Bidstrup PE, Johansen C, Kroman N, Belmonte F, Duriaud H, Dalton SO, Andersen KG, Mertz B. Effect of a Nurse Navigation Intervention on Mental Symptoms in Patients With Psychological Vulnerability and Breast Cancer: The REBECCA Randomized Clinical Trial. JAMA Netw Open. 2023 Jun 1;6(6):e2319591. doi: 10.1001/jamanetworkopen.2023.19591. PMID: 37351885; PMCID: PMC10290249.	wrong intervention
Chen CY, Ding H, Wang SS. Effectiveness of Roy Adaptation Model-Based Cognitive Stimulation Therapy in Elderly Patients with Non-Small Cell Lung Cancer Undergoing Curative Resection. Tohoku J Exp Med. 2024 May 24;263(1):27-34. doi: 10.1620/tjem.2023.J108. Epub 2024 Jan 12. PMID: 38220169.	wrong population (not necessarily pain at baseline)
Heinrich R, Schilling G, Wojtyna E, Arnold D, Geisler M, Kley S, Grudzinski P, Księżak M, Schoenfelder T. Effects of Mobile Application-Based Cognitive Behavioral Therapy on Psychological Outcomes in Women Treated for Breast Cancer: A Randomized Controlled Pilot Trial in Germany. Psychooncology. 2024 Oct;33(10):e70003. doi: 10.1002/pon.70003. PMID: 39439014.	wrong population (no pain), wrong outcomes
Liu X, Wang C, Li Y, Wang Y. Effects of cognitive behavioral and psychological intervention on social adaptation, psychological resilience and level of hope in patients with nasopharyngeal carcinoma in radiotherapy. Pak J Med Sci. 2024 Jan-Feb;40(1Part-I):95-100. doi: 10.12669/pjms.40.1.7421. PMID: 38196484; PMCID: PMC10772449.	wrong population (no pain), wrong outcomes
Abe H, Inoue R, Tsuchida R, Ando M, Saita K, Konishi M, Edamura T, Ogawa A, Matsuoka Y, Sumitani M. Efficacy of treatments for pain and numbness in cancer survivors: a systematic review and meta-analysis. Ann Palliat Med. 2022 Dec;11(12):3674-3696. doi: 10.21037/apm-22-420. Epub 2022 Nov 18. PMID: 36408559.	Interventions do not match with PICO
Chang YC, Tseng TA, Lin GM, Hu WY, Wang CK, Chang YM. Immediate impact of Mindfulness-Based Cognitive Therapy (MBCT) among women with breast cancer: a systematic review and meta-analysis. BMC Womens Health. 2023 Jun 22;23(1):331. doi: 10.1186/s12905-023-02486-x. PMID: 37349700; PMCID: PMC10288664.	Only patients with breast cancer
Fang P, Tan L, Cui J, Yu L. Effectiveness of Acceptance and Commitment Therapy for people with advanced cancer: A systematic review and meta-analysis of randomized controlled trials. J Adv Nurs. 2023 Feb;79(2):519-538. doi: 10.1111/jan.15543. Epub 2022 Dec 19. PMID: 36534441.	Only two studies matching with PICO (for outcome pain)
Feng B, Hu X, Lu WW, Wang Y, Ip WY. Are mindfulness treatments effective for pain in cancer patients? A systematic review and meta-analysis. Eur J Pain. 2022 Jan;26(1):61-76. doi: 10.1002/ejp.1849. Epub 2021 Aug 12. PMID: 34369040.	Not the best SR: intervention is mindfulness
Kumar J, Alam MM, Johnson KC. Nonpharmacological Interventions for Pain Management in Lung Cancer Patients: A Systematic Review. Indian J Palliat Care. 2020 Oct-Dec;26(4):444-456. doi: 10.4103/IJPC.IJPC_24_20. Epub 2020 Nov 19. PMID: 33623305; PMCID: PMC7888434.	Only patients with lung cancer
Li H, Wong CL, Jin X, Chen J, Chong YY, Bai Y. Effects of Acceptance and Commitment Therapy on health-related outcomes for patients with advanced cancer: A systematic review. Int J Nurs Stud. 2021 Mar;115:103876. doi: 10.1016/j.ijnurstu.2021.103876. Epub 2021 Jan 12. PMID: 33517079.	Narrative synthesis; Only three studies matching with PICO
Ruano A, García-Torres F, Gálvez-Lara M, Moriana JA. Psychological and Non-Pharmacologic Treatments for Pain in Cancer Patients: A Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2022 May;63(5):e505-e520. doi: 10.1016/j.jpainsymman.2021.12.021. Epub 2021 Dec 22. PMID: 34952171.	Not the best SR: only 3 studies match with PICO
Wu Y, Pan J, Lu Y, Chao J, Yu H. Psychotherapy for advanced cancer patients: A meta-analysis of the quality of life and survival assessments. Palliat Support Care. 2023 Apr;21(2):301-307. doi: 10.1017/S1478951522000694. PMID: 35678169.	No raw data presented
Cillessen L, Johannsen M, Speckens AEM, Zachariae R. Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials. Psychooncology. 2019 Dec;28(12):2257-2269. doi: 10.1002/pon.5214. Epub 2019 Sep 11. PMID: 31464026; PMCID: PMC6916350.	Only two studies matching with PICO
Herbert MS, Dochat C, Wooldridge JS, Materna K, Blanco BH, Tynan M, Lee MW, Gasperi M, Camodeca A, Harris D, Afari N. Technology-supported Acceptance and Commitment Therapy for chronic health conditions: A systematic review and meta-analysis. Behav Res Ther. 2022 Jan;148:103995. doi: 10.1016/j.brat.2021.103995. Epub 2021 Nov 12. PMID: 34800873; PMCID: PMC8712459.	Only three studies matching with PICO
Matis J, Svetlak M, Slezackova A, Svoboda M, Šumec R. Mindfulness-Based Programs for Patients With Cancer via eHealth and Mobile Health: Systematic Review and Synthesis of Quantitative Research. J Med Internet Res. 2020 Nov 16;22(11):e20709. doi: 10.2196/20709. PMID: 33196452; PMCID: PMC7704284.	Only three studies matching with PICO
Saeidzadeh S, Kamalumpundi V, Chi NC, Nair R, Gilbertson-White S. Web and mobile-based symptom management interventions for physical symptoms of people with advanced cancer: A systematic review and meta-analysis. Palliat Med. 2021 Jun;35(6):1020-1038. doi: 10.1177/02692163211006317. Epub 2021 Apr 12. PMID: 33840271.	Not the best SR: Only four studies about CBT and pain
Zhang A, Wang K, Blumenstein K, Brose A, Kemp C, Meister D, Solomon P. For whom and what outcomes does cognitive-behavioral-therapy work among cancer survivors: a systematic review and meta-analysis. Support Care Cancer. 2022 Nov;30(11):8625-8636. doi: 10.1007/s00520-022-07337-3. Epub 2022 Aug 30. PMID: 36040671.	Wrong outcome: Only overall treatment effect for pain
Zhang T, Wakefield CE, Ren Z, Chen W, Du X, Shi C, Lai L, Zhao C, Gao Y, Chen Z, Zhou Y, Wu T, Cai M. Effects of digital psychological interventions on physical symptoms in cancer patients: A systematic review and meta-analysis. Gen Hosp Psychiatry. 2023 Sep-Oct;84:47-59. doi: 10.1016/j.genhosppsych.2023.05.016. Epub 2023 Jun 2. PMID: 37385139.	Not the best SR: Only four studies about cognitive behavioral therapy and pain; intervention only digital
He CC, Lin DM, Liu HZ, Wang FF, Guo XF, Zhang XB, Ai YQ, Meng LM. Nonpharmacological Interventions for Management of the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Breast Cancer Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. J Pain Res. 2023 Aug 7;16:2713-2728. doi: 10.2147/JPR.S409798. PMID: 37577159; PMCID: PMC10417742.	Only patients with breast cancer
Winger JG, Kelleher SA, Ramos K, Check DK, Yu JA, Powell VD, Lerebours R, Olsen MK, Keefe FJ, Steinhauser KE, Porter LS, Breitbart WS, Somers TJ. Meaning-centered pain coping skills training for patients with metastatic cancer: Results of a randomized controlled pilot trial. Psychooncology. 2023 Jul;32(7):1096-1105. doi: 10.1002/pon.6151. Epub 2023 May 12. PMID: 37173865; PMCID: PMC10330450	Wrong outcomes: follow-up does not match PICO

Verantwoording

Beoordelingsdatum en geldigheid

Publicatiedatum : 12-03-2026

Beoordeeld op geldigheid :

Initiatief en autorisatie

Initiatief:

Cluster Pijnmanagement

Geautoriseerd door:

Nederlandse Internisten Vereniging
Nederlandse Vereniging van Revalidatieartsen
Nederlandse Vereniging voor Anesthesiologie
Nederlands Instituut van Psychologen
Nederlandse Vereniging van Anesthesiemedewerkers
Samenwerkingsverband Pijnpatiënten naar één stem

Samenstelling werkgroep

Voor het ontwikkelen van de richtlijnmodule is in 2022 een multidisciplinair cluster ingesteld. Het cluster pijnmanagement bestaat uit meerdere richtlijnen, zie hier voor de actuele clusterindeling. De stuurgroep bewaakt het proces van modulair onderhoud binnen het cluster. De expertisegroepsleden brengen hun expertise in, indien nodig. De volgende personen uit het cluster zijn betrokken geweest bij de herziening van deze module:

Clusterstuurgroep

Dr. J.W. (Jan Willem) Kallewaard, anesthesioloog-pijnspecialist, NVA (voorzitter)
Drs. M.O. (Maarten) Mensink, kinderanesthesioloog en pijnarts, NVA
Drs. E.M. (Esther) Boot, neuroloog, NVN
Dr. K.B. (Kim) Gombert-Handoko, ziekenhuisapotheker, NVZA
Dr. J.L. (Loes) Swaan, revalidatiearts, VRA
Drs. S.J. (Stijn) Westerbos, kinderorthopeed, NOV
Drs. P.J.W.J. (Hans) van Dongen, patiëntvertegenwoordiger, Samenwerkingsverband Pijnpatiënten naar één stem

Clusterexpertisegroep

Prof. dr. M.A.H. (Monique) Steegers, anesthesioloog-pijnspecialist, NVA
Dr. K.T.E. (Kim) Olde Dubbelink, anesthesioloog-pijnspecialist, NVA
Drs. I.L. (Ilona) Thomassen-Hilgersom, patiëntvertegenwoordiger, Samenwerkingsverband Pijnpatiënten naar één stem
Dr. J. (Jitske) Tiemensma, psycholoog, NIP
N.R.C. (Nicole) Lefel, anesthesioloog, NVA
Prof. dr. M.L. (Madelon) Peters, psycholoog, NIP
Drs. N.M.A.J. (Nicole) Zusterheel, revalidatiearts, VRA
Drs. J.A.W. (Judith) de Bruijn – Reijnen, revalidatiearts, VRA

Met ondersteuning van

Dr. F. Willeboordse, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten
Drs. I. van Dijk, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
A. Oost, informatiespecialist, Kennisinstituut van de Federatie Medisch Specialisten

Belangenverklaringen

Een overzicht van de belangen van de clusterleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten via secretariaat@kennisinstituut.nl.

Gemelde (neven)functies en belangen stuurgroep

Naam	Hoofdfunctie	Nevenwerkzaamheden	Persoonlijke financiële belangen	Persoonlijke relaties	Extern gefinancierd onderzoek	Intellectuele belangen en reputatie	Overige belangen	Restrictie
Jan Willem Kallewaard	Anesthesioloog-pijnspecialist Rijnstate en AMC	Beroepsbelangencie NVA sectie pijn nva anesthesioloog in rijnstate en aumc	Geen	Geen	Onderzoek gesponsord door industrie neuromodulatie: boston scientific 50.000 euro; onderzoek naar de effecten van neuromodulatie op pijn bij endometriose 2022-2023. Dhr. Kallewaard is hierbij PI. Neuromodulatie is een klein onderdeel van dit cluster, bij enkele modules is dit of kan dit in de toekomst één van de last-resort behandelopties zijn.Geen	Geen	Geen	Besluit: Wanneer onderwerpen rondom neuromodulatie binnen het cluster worden ontwikkeld (of wanneer er discussie plaats vindt over de prioriering) zal Dhr. Kallewaard niet deelnemen aan de vergadering en zal een vice-voorzitter (Dhr. Mensink) waarnemen als voorzitter.
Maarten Onno Mensink	kinderanesthesioloog - pijnspecialist bij Prinses Máxima Centrum voor kinderoncologie	Beroepsbelangencie NVA sectie pijn nva anesthesioloog in rijnstate en aumc	Geen	Geen	Geen	Geen	Geen	Geen restrictie
Stijn Westerbos	Fellow (oncologische) kinder orthopedie Prinses Maxima centrum Utrecht Cello Kinder orthopedie Wilhelmina kinder ziekenhuis Utrecht	Geen	Geen	Geen	Geen	Geen	Geen	Geen restrictie
Esther Boot	Neuroloog, Rijnstate	Lid van werkgroep pijn NVN	Geen	Geen	Geen	Geen	Geen	Geen restrictie
Kim Gombert-Handoko	Lid werkgroep	Geen	Geen	Geen	Geen	Geen	Geen	Geen restrictie
Loes Swaan	Revalidatiearts in dienst van Rijndam Revalidatie te Rotterdam.	- Lid van de Werkgroep Pijnrevalidatie Nederland van de VRA Onbetaald. - Lid van de Commissie Onderzoek en Onderwijs van het Netwerk Pijnrevalidatie Nederland (onbetaald) - Gastdocent Hogeschool Rotterdam (incidenteel, betaald). - Lid redactie nieuw uit te geven boek over pijnrevalidatie bij Bohn Stafleu van Loghum (onbetaald).	Geen	Geen	Geen	Geen	Geen	Geen restrictie
Hans van Dongen	- gepensioneerd -Vereniging samenwerkingsverband pijnpatiënten naar één stem - penningmeester, vrijwillige functie,	- adviserend lid Projectgroep van het project spiegelprogramma voor het reduceren voorschrijven sterkwerkende opioïden door huisartsen, project van het Academisch Huisartsennetwerk van U MC Amsterdam, vrijwillige functie - adviserend lid bij de subsidieaanvraag van het project "Esketamine-infusies voor refractaire chronische pijn bij patiënten met depressieve en niet-depressieve symptomen, met vacatiegeld (is afgerond); - Stichting Pijn-Hoop, interim-voorzitter en penningmeester, vrijwillige functie, algemene patiëntenorganisatie gericht op chronische pijn; - voorzitter Adviesraad Sociaal Domein Noordwijk, met vacatiegeld; - Stichting Sociale Projekten, voorzitter, vrijwillig	Geen	Geen	Geen	Geen	Geen	Geen restrictie

Gemelde (neven)functies en belangen expertisegroep

Naam	Hoofdfunctie	Nevenwerkzaamheden	Persoonlijke financiële belangen	Persoonlijke relaties	Extern gefinancierd onderzoek	Intellectuele belangen en reputatie	Overige belangen	Restrictie
Monique Steegers	Anesthesioloog-pijnspecialist Amsterdam UMC	Geen	Geen	Geen	PI bij: 1) OMAMA (ZonMw) - onderwerp: effectiviteit laxeermiddelen bij patienten met ver gevorderde kanker en obstipatie en 2) duloxetine versus qutenza (Grunenthal) - onderwerp: effectiviteit van de 2 geneesmiddelen bij pijnlijke chemotherapie geïnduceerde perifere neuropathie Beiden zijn lopende studies	Geen	Geen	Monique Steegers
Kim Olde Dubbelink	Anesthesioloog-pijnspecialist Radboudumc	Geen	Geen	Geen	Geen	Geen	Geen
Ilona Thomassen-Hilgersom	voorzitter Samenwerkingsverband Pijnpatiënten naar één stem	Geen	Geen	Geen	Geen	Geen	Geen	Geen restrictie
Jitske Tiemensma	Clusterhoofd, DICA - teamleider en senior project leider, betaald UD, Erasmus MC - wetenschappelijk onderzoek pijngeneeskunde, betaald	Geen	Geen	Geen	Beurs: 19-1454 (Stichting Erasmus Fonds Pijngeneeskunde) - De hypothalamus-hypofyse-bijnierschors as in complex regionaal pijn syndroom: kan de pathofysiologie verder worden ontrafeld? PI. Toegekend in 2021. Project 2024 geëindigd.	Geen	Geen	Geen restrictie
Madelon Peters	Hoogleraar, Universiteit Maastricht	Geen	Geen	Geen	KWF subsidie onderzoek betreft een studie naar perioperatieve CGT ter voorkoming van chronisch post-operatieve pijn na een borstkanker operatie. PI en project leider. Studie loopt nog ZonMW OC grant naar genitale pijn en seksuele problematiek bij vrouwen met PVD (provoked vulvodynie) en endometriose. PI en project leider.	Geen	Geen	Geen restrictie
Nicole Lefel	Anesthesioloog-pijnspecialist Maastrciht UMC	Geen	Geen	Geen	Geen	Geen	Geen	Geen restrictie
Nicole Zusterzeel	Revalidatiearts Zuyderland MC	Geen	Geen	Geen	Geen	Geen	Geen	Geen restrictie
Judith de Bruijn - Reijnen	Revalidatiearts Adelante	Geen	Geen	Geen	Geen	Geen	Geen	Geen restrictie

Inbreng patiëntenperspectief

Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz

Bij de richtlijnmodule voerden de clusterleden conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uit om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema bij Werkwijze).

Module	Uitkomst raming	Toelichting
Cognitieve gedragstherapie	geen financiële gevolgen	Hoewel uit de toetsing volgt dat de aanbeveling(en) breed toepasbaar zijn (>40.000 patiënten), volgt ook uit de toetsing dat het overgrote deel (±90%) van de zorgaanbieders en zorgverleners al aan de norm voldoet OF het geen nieuwe manier van zorgverlening of andere organisatie van zorgverlening betreft, het geen toename in het aantal in te zetten voltijdsequivalenten aan zorgverleners betreft en het geen wijziging in het opleidingsniveau van zorgpersoneel betref]. Er worden daarom geen substantiële financiële gevolgen verwacht.

Werkwijze

Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Werkwijze. Relevante informatie voor de ontwikkeling/herziening van deze richtlijnmodule is hieronder weergegeven.

Zoekverantwoording

Algemene informatie

Cluster/richtlijn: Cluster pijnmanagement
Uitgangsvraag/modules: Module Wat is het effect van cognitieve gedragstherapie op pijn bij patiënten met kanker?
Database(s): Embase.com, Ovid/Medline, Ovid/PsycInfo	Datum: 18 december 2024
Periode: vanaf 2016	Talen: geen restrictie
Literatuurspecialist: Alies Oost	Rayyan: https://new.rayyan.ai/reviews/1264920/screening
BMI-zoekblokken: voor verschillende opdrachten wordt (deels) gebruik gemaakt van de zoekblokken van BMI-Online https://blocks.bmi-online.nl/
Toelichting: Voor deze vraag is gezocht op de elementen: pijn door kanker cognitieve gedragstherapie De sleutelartikelen worden gevonden met deze search.

Zoekopbrengst

	EMBASE	OVID/MEDLINE	OVID/PSYCINFO	Ontdubbeld
SR	459	180	73	533
RCT	553	291	74	649
Totaal	1012	471	147	1182

Zoekstrategie

Embase.com

No.	Query	Results
#1	('neoplasm'/exp OR 'oncology'/exp OR 'cancer therapy'/exp OR 'cancer patient'/exp OR 'oncologist'/exp OR 'oncological parameters'/exp OR 'functional assessment of cancer therapy'/exp OR neoplasm:ti,ab,kw OR tumor:ti,ab,kw OR tumour:ti,ab,kw OR carcinoma:ti,ab,kw OR neoplastic:ti,ab,kw OR cancer:ti,ab,kw OR oncolog:ti,ab,kw OR oncotherap:ti,ab,kw OR oncotreatment:ti,ab,kw OR malignan:ti,ab,kw OR metastas:ti,ab,kw) AND ('pain'/exp OR 'pain parameters'/de OR 'pain intensity'/exp OR 'pain severity'/exp OR 'pain assessment'/exp OR 'pain measurement'/exp OR 'nociception'/exp OR pain:ti,ab,kw OR nocicept:ti,ab,kw OR nocipercept*:ti,ab,kw OR 'functional health':ti,ab,kw)	548402
#2	'psychotherapy'/exp OR 'behavioral activation therapy'/exp OR (((cognitive OR cognition OR 'problem solving' OR 'behavio* activation') NEAR/3 (therap* OR psychotherap* OR intervention* OR treatment)):ti,ab,kw) OR cbt:ti,ab,kw OR pst:ti,ab,kw OR (((behavior OR behaviour) NEAR/3 pain NEAR/3 (management OR intervention)):ti,ab,kw) OR 'acceptance and commitment':ti,ab,kw OR 'graded expos':ti,ab,kw OR cbsm:ti,ab,kw OR (('cognitive behavio' NEAR/3 stress):ti,ab,kw) OR psychotherap:ti,ab,kw OR mbct:ti,ab,kw OR ((mindfulness NEAR/4 (therap OR cbt OR intervention* OR 'stress reduction')):ti,ab,kw) OR mbsr:ti,ab,kw	394561
#3	#1 AND #2 NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) NOT (('adolescent'/exp OR 'child'/exp OR adolescent:ti,ab,kw OR child:ti,ab,kw OR schoolchild:ti,ab,kw OR infant:ti,ab,kw OR girl:ti,ab,kw OR boy:ti,ab,kw OR teen:ti,ab,kw OR teens:ti,ab,kw OR teenager:ti,ab,kw OR youth:ti,ab,kw OR pediatr:ti,ab,kw OR paediatr:ti,ab,kw OR puber:ti,ab,kw) NOT ('adult'/exp OR 'aged'/exp OR 'middle aged'/exp OR adult:ti,ab,kw OR man:ti,ab,kw OR men:ti,ab,kw OR woman:ti,ab,kw OR women:ti,ab,kw))	4147
#4	#3 AND [2016-2025]/py	1949
#5	'meta analysis'/exp OR 'meta analysis (topic)'/exp OR 'systematic review'/exp OR 'systematic review (topic)'/exp OR 'scoping review'/exp OR 'rapid review'/exp OR 'umbrella review'/exp OR 'cochrane database of systematic reviews'/jt OR 'network meta-analysis'/exp OR 'networkmeta analy':ti,ab,kw OR 'networkmetaanaly':ti,ab,kw OR metaanaly:ti,ab,kw OR 'meta analy':ti,ab,kw OR metanaly:ti,ab,kw OR prisma:ti,ab,kw OR prospero:ti,ab,kw OR metaanali:ti,ab,kw OR 'meta anali':ti,ab,kw OR metanali:ti,ab,kw OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview)):ti,ab,kw) OR (((structured OR systemic) NEAR/3 (review* OR overview* OR synth) NEAR/3 literature):ti,ab,kw) OR ((systemic NEAR/1 review):ti,ab,kw) OR (((systemati OR literature OR database* OR 'data base') NEAR/10 search):ti,ab,kw) OR (((structured OR comprehensive* OR systemic) NEAR/3 search):ti,ab,kw) OR (((literature NEAR/3 (review* OR overview)):ti,ab,kw) AND (search:ti,ab,kw OR database:ti,ab,kw OR 'data base':ti,ab,kw)) OR (('data extraction':ti,ab,kw OR 'data source':ti,ab,kw) AND ('study selection':ti,ab,kw OR 'studies selection':ti,ab,kw)) OR ('search strateg':ti,ab,kw AND 'selection criteria':ti,ab,kw) OR ('data source':ti,ab,kw AND 'data synth':ti,ab,kw) OR medline:ti,ab,kw OR pubmed:ti,ab,kw OR 'pub med':ti,ab,kw OR embase:ti,ab,kw OR cochrane:ti,ab,kw OR (((critical* OR rapid) NEAR/2 (review OR overview* OR synth)):ti) OR ((((critical OR rapid) NEAR/3 (review OR overview* OR synth)):ab) AND (search:ab OR database:ab OR 'data base':ab)) OR metasynth:ti,ab,kw OR 'meta synth':ti,ab,kw OR 'review* of review*':ti,ab,kw	1105020
#6	'clinical trial'/exp OR 'randomization'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp OR 'placebo'/exp OR 'prospective study'/exp OR rct:ab,ti OR random:ab,ti OR 'single blind':ab,ti OR 'randomised controlled trial':ab,ti OR 'randomized controlled trial'/exp OR placebo:ab,ti	4171622
#7	#4 AND #5	459
#8	#4 AND #6 NOT #7	553
#9	#7 OR #8	1012

Ovid/Medline

#	Searches	Results
1	(exp Neoplasms/ or exp Medical Oncology/ or Integrative Oncology/ or exp Oncologists/ or exp Cancer Survivors/ or (neoplasm* or tumor* or tumour* or carcinoma* or neoplastic or cancer* or oncolog* or oncotherap* or oncotreatment* or malignan* or metastas).ti,ab,kf.) and (exp Pain/ or Pain Measurement/ or Pain Management/ or exp Pain Perception/ or pain.ti,ab,kf. or nocicept.ti,ab,kf. or nocipercept.ti,ab,kf. or 'functional health'.ti,ab,kf.)	177462
2	exp Psychotherapy/ or ((cognitive or cognition or 'problem solving' or 'behavio* activation') adj3 (therap* or psychotherap* or intervention* or treatment)).ti,ab,kf. or cbt.ti,ab,kf. or pst.ti,ab,kf. or ((behavior or behaviour) adj3 pain adj3 (management or intervention)).ti,ab,kf. or "acceptance and commitment".ti,ab,kf. or 'graded expos'.ti,ab,kf. or cbsm.ti,ab,kf. or ('cognitive behavio' adj3 stress).ti,ab,kf. or psychotherap.ti,ab,kf. or mbct.ti,ab,kf. or (mindfulness adj4 (therap or cbt or intervention* or 'stress reduction')).ti,ab,kf. or mbsr.ti,ab,kf.	285137
3	(1 and 2) not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/) not ((Adolescent/ or Child/ or Infant/ or adolescen.ti,ab,kf. or child.ti,ab,kf. or schoolchild.ti,ab,kf. or infant.ti,ab,kf. or girl.ti,ab,kf. or boy.ti,ab,kf. or teen.ti,ab,kf. or teens.ti,ab,kf. or teenager.ti,ab,kf. or youth.ti,ab,kf. or pediatr.ti,ab,kf. or paediatr.ti,ab,kf. or puber.ti,ab,kf.) not (Adult/ or adult.ti,ab,kf. or man.ti,ab,kf. or men.ti,ab,kf. or woman.ti,ab,kf. or women.ti,ab,kf.))	1468
4	limit 3 to yr="2016 -Current"	752
5	meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati or scoping or umbrella or "structured literature") adj3 (review* or overview)).ti,ab,kf. or (systemic adj1 review).ti,ab,kf. or ((systemati or literature or database* or data-base) adj10 search).ti,ab,kf. or ((structured or comprehensive* or systemic) adj3 search).ti,ab,kf. or ((literature adj3 review) and (search or database* or data-base)).ti,ab,kf. or (("data extraction" or "data source") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review or overview* or synthes)).ti. or (((critical or rapid) adj3 (review or overview* or synthes)) and (search or database* or data-base)).ab. or (metasynthes or meta-synthes*).ti,ab,kf.	797532
6	exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random.ti,ab. or (clinic adj trial).tw. or ((singl or doubl* or treb* or tripl) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo.tw.	2820861
7	4 and 5	180
8	(4 and 6) not 7	291
9	7 or 8	471

Ovid/PsycInfo

#	Searches	Results
1	(exp Neoplasms/ or exp Oncology/ or exp Oncologists/ or (neoplasm* or tumor* or tumour* or carcinoma* or neoplastic or cancer* or oncolog* or oncotherap* or oncotreatment* or malignan* or metastas).ti,ab,id.) and (exp Pain/ or exp Pain Measurement/ or exp Pain Management/ or exp Pain Perception/ or pain.ti,ab,id. or nocicept.ti,ab,id. or nocipercept.ti,ab,id. or 'functional health'.ti,ab,id.)	10522
2	exp Psychotherapy/ or ((cognitive or cognition or 'problem solving' or 'behavio* activation') adj3 (therap* or psychotherap* or intervention* or treatment)).ti,ab,id. or cbt.ti,ab,id. or pst.ti,ab,id. or ((behavior or behaviour) adj3 pain adj3 (management or intervention)).ti,ab,id. or "acceptance and commitment".ti,ab,id. or 'graded expos'.ti,ab,id. or cbsm.ti,ab,id. or ('cognitive behavio' adj3 stress).ti,ab,id. or psychotherap.ti,ab,id. or mbct.ti,ab,id. or (mindfulness adj4 (therap or cbt or intervention* or 'stress reduction')).ti,ab,id. or mbsr.ti,ab,id.	333095
3	1 and 2	693
4	limit 3 to yr="2016 -Current"	265
5	((literature review or systematic review or meta analysis).md. or "literature review"/ or meta analysis/ or (((meta adj2 analy) or metaanaly or (synthes* adj2 (literature* or research* or studies or data)) or (pooled and analys) or ((data adj1 pool) and studies) or medline or medlars or embase or cinahl or scisearch or psychlit or psyclit or cinhal or cancerlit or cochrane or bids or pubmed or ovid or ((hand or manual or database* or computer) adj1 search) or (electronic adj1 (database* or data base or data bases))).ti,ab,id. or (review* or overview).ti. or (bibliograph* or relevant journals or ((review* or overview) adj9 (systematic or methodologic* or quantitativ* or research* or literature* or studies or trial* or effective))).ab.)) not (((retrospective or record* or case* or patient) adj1 review) or ((patient* or review) adj1 chart)).ti,ab,id.	507545
6	exp clinical trial/ or randomized controlled trial/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random.ti,ab. or (clinic adj trial).tw. or ((singl or doubl* or treb* or tripl) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo.tw.	311270
7	4 and 5	73
8	(4 and 6) not 7	74
9	7 or 8	147

Richtlijnendatabase

Pijn bij patiënten met kanker

Pijn bij patiënten met kanker

Cognitieve gedragstherapie bij pijn bij kanker

Uitgangsvraag

Aanbeveling

Overwegingen

Onderbouwing

Achtergrond

Conclusies / Summary of Findings

Samenvatting literatuur

Zoeken en selecteren

Referenties

Evidence tabellen

Verantwoording

Beoordelingsdatum en geldigheid

Initiatief en autorisatie

Samenstelling werkgroep

Belangenverklaringen

Inbreng patiëntenperspectief

Werkwijze

Zoekverantwoording

Bijlagen