Self-managed Complementary and Integrative Health Approaches for Chronic Pain and PTSD: An Umbrella Review

Chronic pain and posttraumatic stress disorder (PTSD) have shared, often overlapping pathophysiology. Treatment options include complementary and integrative health (CIH) interventions, which have been summarized in numerous systematic reviews and meta-analyses (SR/MAs).

This umbrella review describes and evaluates SR/MAs of self-managed CIH modalities for chronic pain or PTSD.

We registered our protocol and conducted a literature search in October 2022 of Ovid MEDLINE ALL, Ovid APA PsycInfo, and Ovid EBM Reviews Cochrane Central Register of Controlled Trials; an updated search was conducted in January of 2026 of Ovid MEDLINE, Cochrane Database of Systematic Reviews, and APA PsycInfo. Reviews of RCTs published in or after 2017 involving adults with chronic pain or PTSD and limited to CIH interventions that do not require the presence of a provider were retrieved. Two reviewers independently conducted selection, data extraction, and assessment of SR/MA quality using the Revised Assessment of Multiple Systematic Reviews Tool. We extracted study aims, search dates, number of articles and subjects, patient population, interventions, dose, adverse events, comparators, outcomes, and summary estimates for symptom reduction. We followed PRISMA reporting guidelines.

We included 27 (chronic pain (n = 16) and PTSD (n = 11) SR/MAs of yoga, meditation/mindfulness, and tai chi/qigong. Methodological quality scores ranged from 29 to 42 out of 44 points. Efficacy of CIH varied by condition, intervention, and comparator type. Mild adverse events and increases in existing symptoms may arise temporarily when practicing mindfulness, yoga, or tai chi. The length of each intervention session ranged from 30 to 150 min for 8-54 sessions depending on the CIH modality.

Self-managed CIH for chronic pain and PTSD is well documented and may be effective for individuals with comorbid chronic pain and PTSD with low risk of adverse events. CIH approaches that could be used for simultaneous treatment of CP + PTSD should consider interventions that include mindfulness and movement.

PROSPERO Trial CRD42022369478.