Psychosocial interventions for reducing pain and pain-related distress in infants, children, and adolescents undergoing cancer treatment: a systematic review and meta-analysis of randomized control trials

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Pain is a significant burden for children undergoing cancer treatment. Psychosocial interventions offer low-risk strategies to reduce pain and distress. This systematic review and meta-analysis evaluated their effectiveness during paediatric cancer treatment. Six databases and trial registries were searched from inception to November 2025. Eligible studies were randomized controlled trials delivered during cancer treatment or procedures. Outcomes included child self-reported and parent proxy ratings of pain intensity and pain-related distress. We screened 2674 records and included 42 trials involving 2167 children. Most targeted acute procedural pain (k = 35). Twenty-seven trials were included in meta-analysis. Psychosocial interventions reduced child-reported pain intensity (standardised mean difference [SMD] −0.86, 95% confidence interval [CI] −1.35 to −0.37). Moderate-to-large effects were observed for hypnosis, distraction, and mind–body strategies, with moderate effects for technology-based interventions. Cognitive behavioural therapy showed no effect. Significant reductions were observed for child-reported anxiety (SMD −1.54, 95% CI −1.84 to −1.24). Effects on fear and global distress were variable. Parent proxy reports showed reduced postprocedural pain (SMD −0.77, 95% CI −1.36 to −0.18), with inconsistent effects for distress. Risk of bias was low in 17% of trials, with most demonstrating methodological concerns. No adverse events were reported. Evidence remains concentrated in procedural contexts, with limited evaluation of treatment-related or chronic pain. Infants and children with neurocognitive impairment were underrepresented. Psychosocial interventions are associated with reductions in paediatric cancer pain and anxiety. Future multisite trials should extend evaluation across the cancer trajectory and prioritise inclusive designs. PROSPERO registration: CRD42022343066.