[Cognitive-Behavioral therapy for patients with disability associated with chronic pain: systematic review of clinical trials]

Abstract

Objective: To systematically assess the effectiveness of Cognitive Behavioral Therapy (CBT) in reducing disability associated with chronic pain, identifying the most effective therapeutic approaches, key components of the interventions, and clinical conditions that exhibit the greatest improvements

Materials and methods: The systematic review followed the PRISMA methodology. Searches were conducted in PubMed, Embase, and ScienceDirect to identify clinical trials evaluating disability associated with chronic pain in patients treated with CBT, published between January 2019 and January 2024, in English or Spanish. Due to data heterogeneity, a meta-analysis was not feasible, and a narrative synthesis was employed to present the results.

Results: Nineteen studies were analyzed, incorporating various CBT modalities (in-person, digital, and combined with other therapies). 84% of the interventions demonstrated significant improvements in disability related to chronic pain. The most effective modalities included in-person CBT, digital CBT, and Acceptance and Commitment Therapy (ACT). The key components identified were psychoeducation, cognitive restructuring, graded activity, relaxation techniques, emotional regulation, an interdisciplinary approach, and the use of technology. Conditions showing the greatest improvements included chronic low back pain, generalized chronic pain, migraine with comorbid depression, and chronic pain in patients with prolonged opioid use.

Conclusion: CBT is effective in reducing disability in patients with chronic pain, with greater benefits observed when combined with other strategies. Its implementation in primary care settings could enhance initial pain management and prevent the chronicity of disability.