Systematic review and meta-analyses of nonpharmacological interventions for co-occurring chronic pain and posttraumatic stress disorder

Abstract 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.