Tulipani, C., Morelli, F., Spedicato, M.R., Maiello, E., Todarello, O., & Porcelli, P. (2010). Alexithymia and cancer pain: The effect of psychological intervention. Psychotherapy and Psychosomatics, 79(3), 156–163.

To evaluate the impact of psychological intervention on pain perception and levels of alexithymia in patients with cancer

For six months, patients were randomly included in a psychological intervention or control group. The intervention consisted of biweekly 90-minute sessions provided by a clinical psychologist trained in psychotherapy and psycho-oncology. Main aspects included psychoeducation regarding mechanisms of pain, daily management of cancer-related issues, emotional reaction to illness, problem solving, cognitive restructuring of dysfunctional illness-related concerns and beliefs, stress management, and progressive relaxation. Investigators assessed outcomes at baseline and at the end of the study. Authors did not describe the control condition.

• The sample was composed of 104 patients.
• Mean patient age was 47.4 years.
• Of all patients, 55.8% were female and 44.2% were male.
• Subjects had a variety of cancer types. Gastrointestinal was the most frequent. Of all patients, 37.5% had metastatic disease. The average length of education was fewer than 10 years. Of all patients, 79.8% were married and 90% were receiving chemotherapy with or without radiation therapy.

• Single site
• Outpatient
• Italy

Randomized controlled trial

• Brief Pain Inventory
• Toronto Alexithymia Scale (TAS-20)
• Mental Adjustment to Cancer Scale
• Illness Behavior Questionnaire
• Hospital Anxiety and Depression Scale subscales for anxiety and depression
• SF-12

Control patients were significantly younger and had more progressive cancer than those in the intervention group (p = 0.01). In multiple regression analysis, only alexithymia and scores from the physical component of the SF-12 were predictive of pain intensity (p < 0.001). Patients with progressive disease had higher pain intensity, more interference with daily living, and worse pain (p < 0.001). At the end of six months, compared to controls, patients who received the intervention had significantly lower scores relating to pain intensity (p = 0.03), alexithymia (p < 0.001), hypochondriasis (p = 0.016), and disease perception (p = .013) and showed improvement in these problems from baseline (p < 0.007).

Findings of this study showed that the psychological intervention tested seemed to have a positive effect on pain and alexithymia in patients with cancer. Alexithymia was predictive of pain intensity.

• The study had risks of bias due to no appropriate control group, no attentional control, and no blinding. Authors did not describe the control condition.
• Authors did not discuss other interventions provided to manage pain, so whether differences and changes in medical management of pain influenced results is unknown.
• The control group had more progressive cancer and was younger. Both factors could have influenced pain and other outcomes.
• Authors did not state whether patients in the intervention group attended all sessions.
   

Findings suggest that psychological intervention, including cognitive behavioral techniques and progressive relaxation, can be helpful to patients in regard to management of pain; however, limitations of the study design must be considered when interpreting results. The intervention provided was time-consuming and would be associated with cost, which was not discussed. Future researchers should construct well-designed studies to determine the most helpful type and dosage of interventions of this type.