Efficacy of cognitive behavioral therapy for musculoskeletal pain: a systematic review and meta-analysis

Chronic musculoskeletal pain is a prevalent condition that causes substantial personal and societal burden, yet the effectiveness of non-pharmacological interventions remains debated. Cognitive behavioral therapy (CBT) and CBT-oriented cognitive-based interventions have been increasingly applied to pain management, but evidence has been fragmented across populations and treatment modalities. This study aimed to provide an updated synthesis of randomized controlled trials (RCTs) evaluating the efficacy of CBT for chronic musculoskeletal pain.

We conducted a systematic search of PubMed, Web of Science, Scopus, Embase, PsycINFO, and the Cochrane Library. Eligible studies were screened according to predefined criteria, quality was assessed using the Cochrane Risk of Bias 2 tool (ROB 2.0) and statistical analyses were performed in Stata 15.1.

Fourteen high-quality RCTs involving 2,677 patients were included. Meta-analysis indicated that CBT significantly reduced pain catastrophizing (SMD = -0.77, 95% CI: -1.10 to -0.43, p < 0.05), pain intensity (SMD = -0.41, 95% CI: -0.62 to -0.20, p < 0.05), and functional disability (SMD = -0.20, 95% CI: -0.36 to -0.03, p < 0.05). Subgroup analyses of pain intensity further identified a cluster of six studies showing consistent intervention effects (SMD = -0.22, p < 0.001), although the specific factors underlying this consistency remain unclear. Functional disability outcomes varied by measurement tool, with significant and homogeneous effects in the RMDQ subgroup (SMD = -0.21, p < 0.05) but nonsignificant, heterogeneous results in the ODI subgroup. For catastrophizing, both CBT and pain-coping skills training (PCST) significantly reduced scores (SMD = -0.74 and -0.89, respectively).

These findings suggest that CBT exerts consistent therapeutic benefits for chronic musculoskeletal pain, supporting its role as a reliable clinical non-pharmacological treatment option.

This study protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD420251073898).