PAIN+ CPN

OBJECTIVES: This systematic review and meta-analysis aimed to assess the effect of behavioral interventions that include goal setting on pain, disability, and physical activity in people with chronic musculoskeletal pain.

METHODS: Five electronic databases (PubMed, CENTRAL [Cochrane Library], PEDro, PsycINFO, and CINAHL) and 3 clinical trial registers (ClinicalTrials.gov, ANZCTR, and ISRCTN) were searched from inception to August 2025 for randomized controlled trials of behavioral interventions with goal setting compared with matched comparators without goal setting, usual care, or wait-list. Screening, data extraction, risk of bias (RoB2), and certainty of evidence assessments (GRADE) were conducted in duplicate. We performed random-effects meta-analyses to estimate effects on pain, disability, and physical activity.

RESULTS: Thirty-six trials involving 7275 participants (mean age 57.2±9.2 y; 61.6% female) were included. Compared with matched comparators at postintervention, behavioral interventions that include goal setting may reduce pain (SMD -0.32, 95% CI: -0.58 to -0.06, very low certainty) and disability (SMD -0.52, 95% CI: -0.90 to -0.15; low certainty) and increase physical activity (SMD 0.88, 95% CI: -0.32 to 2.07), but the effect is imprecise and very uncertain. Usual care and wait-list comparisons found varied effects on outcomes postintervention, based on moderate to very low certainty evidence.

DISCUSSION: Behavioral interventions that include goal setting may produce small improvements in pain and disability in adults with chronic musculoskeletal pain, but effects on physical activity are unclear. If clinicians choose to include goal setting within a behavioral intervention, they should consider how it could be best implemented to guide behaviour change and support evidenced-based management.

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