Chronic low back pain is associated with compromised cognitive function: A systematic review and meta-analysis

We compared domain-specific cognitive function between adults with chronic low back pain (CLBP) and pain-free controls. PubMed, CINAHL, PsycINFO, EMBASE, and CENTRAL were searched from inception to 21 February 2025. Pairwise random-effects meta-analysis estimated standardised mean difference (Hedges' g). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach assessed certainty of evidence. JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies assessed risk of bias. Twenty-six studies (participants: 5572) were included. Compared to pain-free controls, adults with CLBP performed worse on tests of executive function (g [95%CI]: 0.50 [0.27, 0.74], P<0.001, GRADE: very low), global cognition (-0.23 [-0.43, -0.04], P=0.018, GRADE: low), memory (-0.65 [-0.90, -0.41], P<0.001, GRADE: very low), motor skills (0.44 [0.25, 0.64], P<0.001, GRADE: very low), and processing speed (0.27 [0.03, 0.51], P=0.027, GRADE: very low), yet not attention (-0.32 [-1.29, 1.68], P=0.363, GRADE: very low), language (-0.57 [-4.27, 3.13], P=0.302, GRADE: very low), and perception (-0.19 [-1.43, 1.05], P=0.584, GRADE: very low). CLBP may be associated with slightly worse global cognition. CLBP may also be associated with worse executive function, memory, motor skills, and processing speed, but the evidence is very uncertain. While there is a lack of evidence regarding causal mechanisms, assessing cognitive function among adults with CLBP appears warranted. Registration: PROSPERO (CRD42022356396). PERSPECTIVE: This systematic review and meta-analysis compared domain-specific cognitive function between adults with chronic low back pain and pain-free controls. While there is a lack of evidence regarding causal mechanisms, assessing cognitive function among adults with chronic low back pain appears warranted.