PAIN+ CPN

Chronic pain and posttraumatic stress disorder (PTSD) frequently co-occur; however, evidence for effective nonpharmacological treatments is limited, resulting in a guidance gap for clinicians. The aim of this systematic review with meta-analysis was to synthesize and analyze the evidence base for nonpharmacological interventions for chronic pain and posttraumatic stress symptoms. MEDLINE, Embase, PsycINFO, and the PTSD Repository were searched for randomized controlled trials of noninvasive, nonpharmacological interventions in adults with chronic pain, PTSD, or both published from January 1, 1988 to August 31, 2024. Studies reporting assessments of both pain intensity and PTSD symptoms were included, and the primary outcomes were change in pain intensity and PTSD symptom severity. Meta-analyses calculated standardized mean differences (SMDs) in change scores for PTSD symptom severity and pain intensity from pre- to posttreatment. Confidence in the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). The study is registered with PROSPERO, CRD42024507881. We identified 30 eligible trials (N = 3245 participants). We found evidence (low quality) that trauma-focused treatments may improve both PTSD symptom severity (a medium effect; SMD -0·75, 95% CI -1·37 to -0·12) and pain intensity (a small effect; SMD -0·34, 95% CI -0·56 to -0·11). We found no significant effects for cognitive-behavioral therapies, mind-body therapies, or peripheral modulation interventions for either outcome. Most studies were methodologically weak. Our findings suggest that treatments targeting chronic pain and PTSD should, at minimum, include a trauma-focused therapy component. However, further research is required to develop effective treatments for co-occurring chronic pain and PTSD.

Physician rater

This systematic review demonstrates rigorous methodology but is constrained by substantial heterogeneity (I²=85.8%), predominantly low-quality evidence (74% high/some risk of bias), and retrospective self-report data. While addressing a critical clinical gap, findings that trauma-focused therapies yield medium effects for PTSD but only small effects for pain are limited by heterogeneous study populations and single-condition targeting, reducing direct applicability to comorbid cases. The work represents an incremental update that highlights methodological deficiencies rather than providing practice-changing recommendations.

Physician rater

As a geriatric psychiatrist, these results make sense but aren't necessarily what I would have expected. These findings provide evidence for the utility of trauma-focused therapy for treating both PTSD and chronic pain. This will help guide my own clinical practice as well as provide support for potential policicies for pain clinics looking to improve patient outcomes.

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