Mindfulness Interventions for Adolescents With Chronic Pain: A Systematic Review and Meta-Analysis.

Mindfulness-based interventions for adolescents with chronic pain are associated with improvements in pain intensity, catastrophizing, acceptance, interference, functioning, quality of life, depression, and anxiety, with moderate to large effect sizes at follow-up. A systematic review and meta-analysis of 14 studies including 323 adolescents found significant within-group improvements across all outcomes, though heterogeneity was moderate to high and certainty low due to risk of bias and pre-post designs. Variable-length interventions showed greater pre-post changes than standardized long interventions. Rigorous randomized controlled trials are needed to substantiate these results.

Study at a glance

Abstract

Despite growing interest in mindfulness-based interventions for adolescents with chronic pain, the data have not been systematically summarized. We conducted a systematic review and meta-analyses to estimate the effect of mindfulness-based interventions on pain intensity, catastrophizing, acceptance and interference; functioning, quality of life, and anxiety and depression in youth with chronic pain. Electronic databases CINAHL, CCTR, Embase, Medline, PsycINFO, Scopus and Web of Science were systematically searched to January 2, 2025. Studies were included if they were in English, included > 5 patients, were not part of intensive interdisciplinary pain treatment and included pre-post outcomes from mindfulness-based interventions delivered to adolescents with chronic pain. Risk of bias was assessed with the Newcastle-Ottawa Scale. Fourteen studies including a total of 323 adolescents were identified. There were significant within group improvements in pain intensity, pain catastrophizing, pain acceptance, pain interference, functioning, depression, anxiety, and quality of life, with results maintained or increased at follow-up effect sizes at follow-up were moderate to large (e.g., quality of life SMD = 0.33; pain intensity SMD = -0.73; pain interference SMD = -1.44). Heterogeneity of results was generally moderate to high. Compared to standardized long interventions, variable length interventions showed greater pre-post changes in functioning, pain intensity, and pain catastrophizing. The certainty in the estimates was generally low, due to risk of bias and pre-post designs. Although adolescents with chronic pain report improvements after participating in mindfulness-based interventions, rigorous RCTs are needed to substantiate these results. Chronic pain in youth is common and difficult to treat. Previous interventions have largely been based on cognitive-behavioural therapy and not successful for all. This is the first systematic review and meta-analysis in paediatric chronic pain to focus on mindfulness-based interventions, highlighting an alternative and potentially effective intervention approach. This study informs clinicians about an effective intervention approach and assists researchers in identifying gaps for further research.