Major clinical approaches in the treatment of chronic pain through cognitive-behavioral and lifestyle therapy: a systematic review

Abstract

Introduction: It is estimated that millions of people worldwide suffer from chronic pain, which is a condition influenced by biological, psychological, and social factors and optimally managed by treatments that address not only its biological causes but also its psychological and social influences and consequences. Over the past 60 years, parallel advances in the scientific understanding of pain and the development of cognitive and behavioral therapies have led to the widespread application of cognitive-behavioral therapy (CBT) to chronic pain problems. Objective: This was to conduct a systematic review to demonstrate, through randomized clinical trials and meta-analyses, the real impact of treating chronic pain through cognitive-behavioral therapy. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from August to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 84 articles were found. 21 articles were evaluated and 07 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 29 studies with a high risk of bias and 22 studies that did not meet GRADE. Most studies presented homogeneity in their results, with X2= 88.7% >50%. It was concluded that the effectiveness of cognitive-behavioral therapy for individuals with chronic pain has been evaluated in randomized clinical trials for more than three decades, mainly in adults with chronic back pain, headaches, orofacial pain, or arthritis-related pain. Cognitive-behavioral therapy is the “gold standard” psychological treatment for individuals with a wide range of pain problems. The effectiveness of cognitive-behavioral therapy in reducing pain, distress, pain interference with activities, and disability has been established in systematic reviews and meta-analyses. Although the average effect sizes are small to moderate across all pain outcomes, CBT does not have the risks associated with chronic pain medications, surgeries, and interventional procedures. Furthermore, CBT may well have benefits for common comorbid conditions such as diabetes and cardiovascular disease. Research is needed to develop CBT interventions that have stronger beneficial effects, with attention to whether tailoring therapy to specific patient subgroups or problems improves outcomes.