PAIN+ CPN

There is a large proportion of people living with chronic pain who also experience posttraumatic stress symptoms; however, there is no current standard treatment for addressing these mutually maintaining conditions. The aim of this systematic review and meta-analysis was to examine the efficacy of psychotherapeutic interventions for adults with chronic pain and trauma symptoms, where the effects of psychotherapy could be isolated. Systematic searches were conducted in 5 databases (MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and APA PsycINFO) until October 8, 2025. Randomized controlled trials were included if they had a psychological intervention component addressing chronic pain and/or trauma exposure/trauma-related symptoms. Methodological quality was assessed using the Cochrane risk of bias tool. Eighteen studies met our inclusion criteria with 61% having high risk of bias. The results revealed that psychological interventions were found to significantly reduce pain intensity (SMD = 0.34 [95% CI, 0.10-0.58]), pain interference (SMD = 0.20 [95% CI, 0.004-0.39]), and trauma-related symptoms (SMD = 0.36 [95% CI, 0.22-0.51]), as compared with controls, immediately after the interventions with sustained effects 3 to 6 months postintervention (SMD = 0.40 [95% CI, 0.29-0.52], SMD = 0.20 [95% CI, 0.05-0.36], and SMD = 0.38 [95% CI, 0.20-0.55]). Our findings suggest that psychological interventions may effectively reduce pain and trauma symptoms in populations with overlapping pain and trauma-related presentations, but larger, rigorous trials are needed to identify mechanisms of change and determine which interventions work best for whom.

Physician rater

It would be more useful to focus on both domains together.

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