Psychological treatments for the management of pain following musculoskeletal injury: a systematic review and meta-analysis

Rachel Aaron, Fenan Rassu, Stephen Wegener, Amy L. Holley, Renan Castillo, Greg Osgood, Emma Fisher

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Musculoskeletal injury is a leading cause of pain and disability worldwide; 35-75% of people experience persistent pain for months and years after injury. Psychological treatments can reduce pain, functional impairment and psychological distress, but are not widely utilized following injury. This systematic review and meta-analysis (PROSPERO ID: CRD42021236807) aimed to synthesize the literature testing psychological treatments for pain following musculoskeletal injury. We searched EMBASE, MEDLINE, PubMed, PsycINFO, and CENTRAL from inception to May 2022. We extracted participant, treatment, and injury characteristics, and primary (e.g., pain intensity, functional impairment, depression, anxiety, PTSD symptoms) and secondary (treatment feasibility and acceptability) outcomes. 24 RCTs (N = 1,966) were included. Immediately post-treatment, people who received psychological treatments (versus any control) reported lower pain intensity (SMD = -0.25, 95% CI [-0.49, -0.02]), functional impairment (SMD = -0.32 [-0.55, -0.09]), and symptoms of depression (SMD = -0.46 [-0.64, -0.29]), anxiety (SMD = -0.34 [-0.65, -0.04]) and PTSD (SMD = -0.43 [-0.70, -0.15]); at 6-month follow-up, only depression symptoms were significantly lower. Included trials varied widely in treatment and injury characteristics. The certainty of evidence was low or very low for most effects, and heterogeneity moderate to substantial. Most studies had risk of bias domains judged to be high or unclear. Due to very low certainty of results, we are unsure whether psychological therapies reduce pain and functional impairment following musculoskeletal injury; they may result in improved depression immediately post-treatment and at follow-up. More research is needed to identify treatments that result in enduring effects.
Original languageEnglish
Early online date25 Jul 2023
Publication statusPublished - 31 Dec 2023

Bibliographical note

This work was supported by the Johns Hopkins Clinician Scientist Award (RVA), NIH K23HD104934 (RVA), DOD W81XWH-16-2-0060 (RVA, STW, RCC) DOD JW160020 (STW), NIDILRR H133G140079 (STW), and Versus Arthritis (Career Development Fellowship; EF).


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