Efficacy of cognitive behavioral therapy for reducing pain susceptibility and increasing social engagement in patients with chronic low back pain: A systematic review and meta-analysis

BACKGROUND: The objective of this study was to evaluate the efficacy of cognitive behavioral therapy in improving social engagement and pain susceptibility in patients with chronic low back pain (≥6 months duration). METHODS: From the initial to January 2023, 5 databases were searched for randomized controlled trials, literature screening, quality evaluation, and data extraction were performed by 2 independent researchers throughout, Meta-analysis was performed using RevMan 5.4 software, standardized mean difference (SMD) was calculated for different indicators, and the combined experimental and control groups were calculated using random-effects models or fixed-effects models effect sizes, and forest plots were drawn to present the results. RESULTS: A total of 16 studies containing 2527 patients with chronic nonspecific low back pain, all of whom had pain lasting longer than 6 months, were included, and after treatment, cognitive behavioral therapy (CBT) was superior to other treatments in improving social participation [SMD = −0.30, 95%CI (−0.60, −0.01), Z = 2.02, P = .04]. There was no significant difference from other treatments in improving patient depression [SMD = −0.07, 95%CI (−0.19, 0.05), Z = 1.11, P = .27] and anxiety [SMD = −0.07, 95%CI (−0.30, 0.16), Z = 0.52, P = .57]. Three papers describe the superiority of CBT over other treatments in improving sleep quality, but the metrics could not be combined due to too little literature. CONCLUSION: CBT can improve patients’ social participation and pain susceptibility to some extent, but it does not show advantages for managing negative emotions (depression, anxiety). Due to the limited number and low quality of included literature, the above findings still need to be validated by conducting a large sample of high-quality RCTs.