The Effects of Mindfulness-Based Programs on Pain-Related Cognitions in Individuals With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis.
Talia Barnet-Hepples, Fereshteh Pourkazemi, Evangelos Pappas, Linting Ruan, James Puterflam, Jemma Masterton, Anita B Amorim
Pain research & management 2026 DOI: 10.1155/prm/6495015 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis of randomized controlled trials Peer reviewed |
|---|---|
| Sample size | 5,997 |
| Population | Individuals with chronic musculoskeletal pain |
| Intervention | Mindfulness-based programs |
| Topics | Meditation |
| Keywords | Chronic musculoskeletal pain Meta-analysis Mindfulness-based programs Pain-related cognitions Systematic review |
| Key findings | Compared with no intervention, mindfulness-based programs reduced pain catastrophizing (SMD 1.00) and increased pain acceptance (SMD 1.12) after treatment, and also reduced depression, anxiety, psychological distress, pain intensity, and disability. Effects were largely similar to cognitive behavioral therapy. The authors conclude the programs appear effective for self-management, though evidence certainty is mostly low and adherence varied. |
Abstract
Chronic musculoskeletal pain is a complex condition influenced by psychological factors, including pain-related cognitions. This systematic review and meta-analysis of randomized controlled trials aimed to evaluate the effects of mindfulness-based programs on pain-related cognitions in individuals with chronic musculoskeletal pain. Secondary outcomes included depression, anxiety, psychological distress, pain intensity, disability, intervention adherence, and mindfulness-related adverse events. Eight databases were searched from inception to January 2026. Evidence was synthesized using random-effects models and reported as standardized mean differences with 95% confidence intervals. Risk of bias was assessed using the revised Cochrane risk of bias tool. Evidence certainty was rated using GRADE. Fifty-one studies (n = 5997) were included and had a moderate-to-high risk of bias. Compared to no intervention, mindfulness-based programs reduced pain catastrophizing (SMD: 1.00, 95% CI: 0.56-1.45) and increased pain acceptance (SMD: 1.12, 95% CI: 0.31-1.92) post-intervention. They also reduced depression (SMD: 0.94, 95% CI: 0.50-1.38), anxiety (SMD: 1.08, 95% CI: 0.57-1.59), psychological distress (SMD: 0.75, 95% CI: 0.12-1.38), pain intensity (SMD: 0.80, 95% CI: 0.38-1.23), and disability (SMD: 0.48, 95% CI: 0.04-0.92) compared to no intervention. Minimal significant differences were observed between the effect of mindfulness-based programs and cognitive behavioral therapy on these outcomes. Mindfulness-based programs appear to be an effective self-management strategy for individuals with chronic musculoskeletal pain. However, the certainty of evidence is mostly low with intervention adherence varying. Future research should clarify the direction and nature of the relationship between adherence and outcomes. Reporting of mindfulness-related adverse events was insufficient to evaluate safety; future trials should incorporate comprehensive measurement.
Comparable studies
Other systematic reviews and meta-analyses on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Meditation Programs for Psychological Stress and Well-being Diverse adult clinical populations | 2014 | Meta-analysis | n = 3,515 |
| Mindfulness-Based Stress Reduction for Stress Management in Healthy People: A Review and Meta-Analysis Healthy subjects | 2009 | Systematic review and meta-analysis | |
| The psychological effects of meditation: A meta-analysis. Nonclinical groups of adult meditators | 2012 | Meta-analysis | n = 163 |
| Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse Adults with recurrent depression in full or partial remission | 2016 | Meta-analysis of individual patient data from randomized controlled trials | n = 1,258 |
| Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy – a systematic review of randomized controlled trials | 2011 | Systematic review |