The impact of complementary interventions on pain and disability in patients with chronic non-cancer pain: A network meta-analysis

Abstract

Background and purpose

Chronic non-cancer pain (CNCP) imposes a substantial burden on individuals and healthcare systems worldwide. Limitations and risks of long-term pharmacological treatment have increased interest in complementary therapies; however, the lack of direct comparisons limits evidence-based decision-making. Therefore, this study aimed to compare complementary therapies for pain and disability using a network meta-analysis.

Methods

A network meta-analysis of randomized controlled trials was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses (PRISMA-NMA) guidelines. Four databases were searched from inception to December 2024, with an update in May 2025. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. A Bayesian random-effects network meta-analysis was performed. Treatment rankings were evaluated using the surface under the cumulative ranking curve (SUCRA), and inconsistency and publication bias were assessed.

Results

Thirty-three randomized controlled trials involving 6196 participants were included. Dry needling ranked highest for pain and disability, but the evidence quality was very low because of substantial heterogeneity. Cognitive behavioral therapy and acupuncture showed moderate-quality evidence and consistent improvements in both outcomes versus wait control. Safety reporting was inconsistent, and reported adverse events were mostly mild and transient.

Conclusion

Cognitive behavioral therapy and acupuncture appear to be reliable options for improving pain and disability in chronic non-cancer pain, supported by moderate-quality evidence. Dry needling may provide short-term benefits but should be interpreted cautiously because of low certainty.