Psychological intervention in patients with central sensitization syndromes and comorbid psychosocial trauma: a systematic review and meta-analysis

The co-occurrence of central sensitization syndromes (CSS) and post-traumatic symptoms (PTSS) or post-traumatic stress disorder (PTSD) exacerbates impairment, and treatment is unsatisfactory in many cases. This systematic review and meta-analysis examined the effectiveness of psychological therapy in individuals with CSS and comorbid PTSS/PTSD. A search of Medline, PsycInfo, Web of Science, Pubmed, and Scopus databases (2000 to 2023) was conducted following PRISMA guidelines. Nineteen articles were selected, including nine for meta-analysis. The main psychological therapies were pain-focused cognitive-behavioral therapy (P-CBT), and trauma-focused interventions, mainly written emotional disclosure (WED) and emotional awareness and expression therapy (EAET). Both EAET and P-CBT showed potential benefits in improving pain severity (specially EAET), PTSS/PTSD, emotional distress, fatigue, sleep disturbances, CSS-related symptoms, and quality of life. Overall, no significant differences were found between the two interventions. The meta-analysis revealed a large effect size for EAET in reducing pain and emotional distress; however, most comparison were against inactive controls, so results should be interpreted cautiously. These findings underscore the importance of distinguishing CSS patients with PTSS/PTSD. Tailored treatments such as EAET can address the additive impact of these conditions and contribute to improving patients' quality of life.