A Systematic Review of the Use of Interoceptive Exposure Interventions in Chronic Pain
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Interoceptive exposure (IE), which refers to a behavioural intervention designed to reduce anxiety sensitivity and distress associated with somatic sensations, has been suggested to be a potentially effective technique in treating chronic pain. This systematic review aims to review the literature on the use of IE interventions for chronic pain, to identify with which populations these interventions can be most effective, and to suggest directions for future research. A comprehensive search of databases, including Scopus, PsycINFO via OVID, Web of Science, and the Cochrane Library, was undertaken to locate and identify relevant studies. A quality assessment of the identified studies was undertaken using a modified Downs and Black checklist for quality assessment. Fourteen studies were identified as relevant and utilised in the analysis, including seven randomised controlled trials. Data central to the study objective were extracted, examined and synthesised, and studies were analysed and categorised into three outcome categories: pain and function outcomes; emotion-related outcomes; and cognitive process outcomes. Findings provided encouraging evidence for the use of IE interventions in reducing pain, increasing function, improving emotional status and cognitive processes. Findings also suggest that IE is an effective intervention that is comparable to other psychosocial strategies for pain management, such as relaxation and distraction. Specifically, IE showed the most potential for people exhibiting high levels of fear before treatment, people with abdominal pain, and people with chronic pain and comorbid posttraumatic stress disorder (PTSD). The findings of this review also highlight the need for more high-quality research on IE as a chronic pain treatment, particularly with regard to the use of active controls and more unified outcome measures. Strengthening future research in this area may pave the way for stronger clinical recommendations.