The Efficacy of Motivational Interviewing in Adults With Chronic Pain: A Meta-Analysis and Systematic Review

  • Dion Alperstein
    Department of Psychology, University of Sydney, Sydney, New South Wales, Australia
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  • Louise Sharpe
    Address reprint requests to Louise Sharpe, PhD, Clinical Psychology Unit, School of Psychology, University of Sydney, Brennan MacCallum Building A 18, Sydney, New South Wales 2006, Australia.
    Department of Psychology, University of Sydney, Sydney, New South Wales, Australia
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Published:November 27, 2015DOI:


      • In this meta-analysis we assessed motivational interviewing (MI) in chronic pain.
      • We assessed the effect of MI on adherence, pain, and physical function.
      • MI appeared to increase short-term adherence to chronic pain treatment.
      • It is unclear whether MI resulted in improvements in pain and physical function.
      • Further research on motivational interventions in chronic pain is needed.


      Motivational interviewing (MI) has become a popular approach for increasing adherence. In this study we investigated whether MI is effective in improving adherence, and pain and physical function for patients with chronic pain. A literature search of randomized controlled trials identified 7 eligible studies with 962 participants with chronic pain. There was a small to moderate overall effect of MI on increased adherence to treatment from baseline to after intervention, but not from baseline to follow-up. Although significant short-term effects of MI were also observed for pain intensity, analyses revealed that this finding might be due to publication bias. There were insufficient studies to examine physical functioning meta-analytically, however, none of the 3 available studies showed that MI resulted in gains in physical function compared with the control group. These results indicate that MI can probably increase short-term adherence to chronic pain treatments, although publication bias cannot be ruled out. Further, it is as yet unclear whether these effects result in improvements in patient function. Although the studies were methodologically strong, they investigated MI in relation to a number of treatments for chronic pain. Future research on the efficacy of MI on adherence to evidence-based self-management interventions for chronic pain is needed.


      MI significantly increased adherence to prescribed chronic pain treatments in the short term, however, effect sizes were small to moderate and publication bias was likely. MI showed some promise in promotion of adherence to pain treatments, but more research is required to confirm its efficacy.

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        • Ang D.
        • Kesavalu R.
        • Lydon J.R.
        • Lane K.A.
        • Bigatti S.
        Exercise-based motivational interviewing for female patients with fibromyalgia: A case series.
        Clin Rheumatol. 2007; 26: 1843-1849
        • Ang D.C.
        • Kaleth A.S.
        • Bigatti S.
        • Mazzuca S.A.
        • Jensen M.P.
        • Hilligoss J.
        • Slaven J.
        • Saha C.
        Research to encourage exercise for fibromyalgia (REEF): Use of motivational interviewing, outcomes from a randomized-controlled trial.
        Clin J Pain. 2013; 29: 296-304
        • Basler H.D.
        • Bertalanffy H.
        • Quint S.
        • Wilke A.
        • Wolf U.
        TTM-based counselling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain - A randomised controlled trial.
        Eur J Pain. 2007; 11: 31-37
        • Borenstein M.
        • Hedges L.
        • Higgins J.
        • Rothstein H.
        Comprehensive Meta-Analysis Version 2.
        Biostat, Englewood, NJ2005
        • Broekmans S.
        • Dobbels F.
        • Milisen K.
        • Morlion B.
        • Vanderschueren S.
        Medication adherence in patients with chronic non-malignant pain: Is there a problem?.
        Eur J Pain. 2009; 13: 115-123
        • Burke B.L.
        • Arkowitz H.
        • Menchola M.
        The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials.
        J Consult Clin Psychol. 2003; 71: 843
        • Butow P.
        • Sharpe L.
        The impact of communication on adherence in pain management.
        Pain. 2013; 154: S101-S107
        • Chilton R.
        • Pires-Yfantouda R.
        • Wylie M.
        A systematic review of motivational interviewing within musculoskeletal health.
        Psychol Health Med. 2012; 17: 392-407
        • Christiansen S.
        • Oettingen G.
        • Dahme B.
        • Klinger R.
        A short goal-pursuit intervention to improve physical capacity: A randomized clinical trial in chronic back pain patients.
        Pain. 2010; 149: 444-452
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Laurence Erlbaum, Hillsdale, NJ1988
        • Cooper H.M.
        Scientific guidelines for conducting integrative research reviews.
        Rev Educ Res. 1982; 52: 291-302
        • Dorflinger L.
        • Kerns R.D.
        • Auerbach S.M.
        Providers’ roles in enhancing patients’ adherence to pain self management.
        Transl Behav Med. 2013; 3: 39-46
        • Ehrlich-Jones L.
        • Lee J.
        • Semanik P.
        • Cox C.
        • Dunlop D.
        • Chang R.W.
        Relationship between beliefs, motivation, and worries about physical activity and physical activity participation in persons with rheumatoid arthritis.
        Arthritis Care Res. 2011; 63: 1700-1705
        • Friedrich M.
        • Gittler G.
        • Arendasy M.
        • Friedrich K.M.
        Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain.
        Spine. 2005; 30: 995-1000
        • Friedrich M.
        • Gittler G.
        • Halberstadt Y.
        • Cermak T.
        • Heiller I.
        Combined exercise and motivation program: Effect on the compliance and level of disability of patients with chronic low back pain: A randomized controlled trial.
        Arch Phys Med Rehabil. 1998; 79: 475-487
        • Habib S.
        • Morrissey S.
        • Helmes E.
        Preparing for pain management: A pilot study to enhance engagement.
        J Pain. 2005; 6: 48-54
        • Hammond A.
        Patient education in arthritis: Helping people change.
        Musculoskeletal Care. 2003; 1: 84-97
        • Hedges L.V.
        • Olkin I.
        Nonparametric estimators of effect size in meta-analysis.
        Psychol Bull. 1984; 96: 573
        • Hedges L.V.
        • Vevea J.L.
        Fixed-and random-effects models in meta-analysis.
        Psychol Methods. 1998; 3: 486
        • Hettema J.
        • Steele J.
        • Miller W.R.
        Motivational interviewing.
        Annu Rev Clin Psychol. 2005; 1: 91-111
        • Jack K.
        • McLean S.M.
        • Moffett J.K.
        • Gardiner E.
        Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review.
        Man Ther. 2010; 15: 220-228
        • Jamison R.N.
        • Ross E.L.
        • Michna E.
        • Chen L.Q.
        • Holcomb C.
        • Wasan A.D.
        Substance misuse treatment for high-risk chronic pain patients on opioid therapy: A randomized trial.
        Pain. 2010; 150: 390-400
        • Janke E.A.
        • Spring B.
        • Weaver F.
        The effect of message framing on self-management of chronic pain: A new perspective on intervention?.
        Psychol Health. 2011; 26: 931-947
        • Jones K.D.
        • Burckhardt C.S.
        • Bennett J.A.
        Motivational interviewing may encourage exercise in persons with fibromyalgia by enhancing self efficacy.
        Arthritis Care Res. 2004; 51: 864-867
        • Kerns R.D.
        • Burns J.W.
        • Shulman M.
        • Jensen M.P.
        • Nielson W.R.
        • Czlapinski R.
        • Dallas M.L.
        • Chatkoff D.
        • Sellinger J.
        • Heapy A.
        • Rosenberger P.
        Can we improve cognitive-behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy.
        Health Psychol. 2014; 33: 938
        • Kolt G.S.
        • McEvoy J.F.
        Adherence to rehabilitation in patients with low back pain.
        Man Ther. 2003; 8: 110-116
        • Lai D.T.
        • Cahill K.
        • Qin Y.
        • Tang J.L.
        Motivational interviewing for smoking cessation.
        Cochrane Database Syst Rev. 2010; : CD006936
        • Leonhardt C.
        • Keller S.
        • Chenot J.F.
        • Luckmann J.
        • Basler H.D.
        • Wegscheider K.
        • Baum E.
        • Donner-Banzhoff N.
        • Pfingsten M.
        • Hildebrandt J.
        • Kochen M.M.
        • Becker A.
        TTM-based motivational counselling does not increase physical activity of low back pain patients in a primary care setting—A cluster-randomized controlled trial.
        Patient Educ Couns. 2008; 70: 50-60
      1. Lipsey MW, Wilson D: Practical Meta-Analysis (Applied Social Research Methods Series, Vol. 49). Thousand Oaks, CA, Sage, 2000

        • Mertens V.C.
        • Goossens M.E.
        • Verbunt J.A.
        • Koke A.J.
        • Smeets R.J.
        Effects of nurse-led motivational interviewing of patients with chronic musculoskeletal pain in preparation of rehabilitation treatment (PREPARE) on societal participation, attendance level, and cost-effectiveness: Study protocol for a randomized controlled trial.
        Trials. 2013; 14: 90
        • Miller L.R.
        • Cano A.
        • Wurm L.H.
        A motivational therapeutic assessment improves pain, mood, and relationship satisfaction in couples with chronic pain.
        J Pain. 2013; 14: 525-537
        • Miller W.R.
        Motivational interviewing with problem drinkers.
        Behav Psychother. 1983; 11: 147-172
        • Miller W.R.
        • Rollnick S.
        Motivational interviewing: Helping people change.
        Guilford Press, New York, NY2012
        • Nevedal D.C.
        • Wang C.
        • Oberleitner L.
        • Schwartz S.
        • Williams A.M.
        Effects of an individually tailored Web-based chronic pain management program on pain severity, psychological health, and functioning.
        J Med Internet Res. 2013; 15: 201
        • Nicholas M.K.
        • Asghari A.
        • Corbett M.
        • Smeets R.J.
        • Wood B.M.
        • Overton S.
        • Perry C.
        • Tonkin L.E.
        • Beeston L.
        Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain?.
        Eur J Pain. 2012; 16: 93-104
        • Nicholas M.K.
        • Asghari A.
        • Sharpe L.
        • Brnabic A.
        • Wood B.M.
        • Overton S.
        • Tonkin L.
        • de Sousa M.
        • Finniss D.
        • Beeston L.
        • Sutherland A.
        • Corbett M.
        • Brooker C.
        Cognitive exposure versus avoidance in patients with chronic pain: Adherence matters.
        Eur J Pain. 2014; 18: 424-437
        • Novy D.M.
        Invited special review: Psychological approaches for managing chronic pain.
        J Psychopathol Behav Assess. 2004; 26: 279-288
        • Prochaska J.O.
        • DiClemente C.C.
        Toward a Comprehensive Model of Change.
        Springer, New York, NY1986
        • Prochaska J.O.
        • DiClemente C.C.
        • Norcross J.C.
        In search of how people change: Applications to addictive behaviors.
        J Addict Nurs. 1993; 5: 2-16
        • Rosenthal R.
        Meta-Analytic Procedures for Social Research.
        Sage, Thousand Oaks, CA1991
        • Sanders K.A.
        • Donahue R.G.
        • Kerns R.D.
        Application of psychological strategies for pain management in primary care.
        J Clin Outcomes Manag. 2007; 14: 603-609
        • Tse M.M.
        • Vong S.K.
        • Tang S.K.
        Motivational interviewing and exercise programme for community-dwelling older persons with chronic pain: A randomised controlled study.
        J Clin Nurs. 2013; 22: 1843-1856
        • Vong S.K.
        • Cheing G.L.
        • Chan F.
        • So E.M.
        • Chan C.C.
        Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with low back pain: a randomized controlled trial.
        Arch Phys Med Rehabil. 2011; 92: 176-183
        • Vriezekolk J.E.
        • Geenen R.
        • van den Ende C.H.
        • Slot H.
        • van Lankveld W.G.
        • van Helmond T.
        Behavior change, acceptance, and coping flexibility in highly distressed patients with rheumatic diseases: Feasibility of a cognitive-behavioral therapy in multimodal rehabilitation.
        Patient Educ Counsel. 2012; 87: 171-177
        • Williams A.C.
        • Eccleston C.
        • Morley S.
        Psychological therapies for the management of chronic pain (excluding headache) in adults.
        Cochrane Database Syst Rev. 2012; : CD007407
        • Yates S.L.
        • Morley S.
        • Eccleston C.
        • de C Williams A.C.
        A scale for rating the quality of psychological trials for pain.
        Pain. 2005; 117: 314-325
        • Zwikker H.
        • van den Bemt B.
        • van den Ende C.
        • van Lankveld W.
        • Broeder A.D.
        • van den Hoogen F.
        • van de Mosselaar B.
        • van Dulmen S.
        Development and content of a group-based intervention to improve medication adherence in non-adherent patients with rheumatoid arthritis.
        Patient Educ Counsel. 2012; 89: 143-151