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The effectiveness of peer support interventions for community‐dwelling adults with chronic non‐cancer pain: a systematic review

Background Chronic non‐cancer pain is a common condition that by its nature requires ongoing self management. Peer support is a method of facilitating self‐management of chronic conditions that has been shown to be effective. Peer support may be useful in overcoming some of the common barriers to chronic pain self‐management, and if successful could reduce the health service burden of this common chronic condition. Objectives To identify the effectiveness of peer support interventions on physical and emotional function, pain, quality of life, self‐efficacy and health service utilization in community dwelling adults with chronic non‐cancer pain, compared to those receiving usual care or other self‐management interventions. Inclusion criteria Types of participants Community‐dwelling adults with chronic (12 weeks or longer) non‐cancer pain. Types of intervention Any peer support intervention, or any intervention that included a defined element of peer support, delivered to groups or individuals in any format, including face‐to‐face, telephone and internet‐based interventions. Types of studies Randomized controlled trials or, in their absence, other quantitative research designs such as non‐randomized controlled trials and before and after studies. Types of outcomes Physical and emotional function, pain, quality of life, self‐efficacy and health service utilization. Due to the lack of standardization of chronic pain outcome measures, any relevant measure of these five domains was considered. Search strategy This review aimed to find both published and unpublished studies using the following three‐step search strategy: (i) An initial limited search of MEDLINE and CINAHL was undertaken using four initial keywords. (ii) All keywords identified from the initial search were utilized in a search of several databases. (iii) The reference lists of all identified reports and articles were searched for additional studies. Data collection and synthesis Two independent reviewers assessed 4078 studies for potential applicability to the review objectives based on the information provided in the title, abstract and subject headings. Thirty‐six full‐text articles were obtained and were likewise appraised for applicability to the review objectives. Twelve studies underwent critical appraisal by the two independent reviewers for methodological validity using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI‐MAStARI). Five studies were included in the review. Data were extracted from the five studies using the standardized data extraction tool from JBI‐MAStARI. There was a high degree of heterogeneity in terms of populations, interventions, outcome measures and comparators, rendering meta‐analysis inappropriate; results were therefore presented in narrative form. Results There is some evidence that peer support may have a beneficial effect on emotional function, pain, quality of life and self‐efficacy in specific subgroups of chronic pain patients; no evidence was found on the effect of peer support on health service utilization. Conclusions There is some evidence that peer support interventions may be more effective than usual care for some groups of patients with chronic non‐cancer pain. However, it is not possible to make specific recommendations for practice until further high‐quality research is conducted.