Effectiveness of cognitive-behavioral therapy in the management of pediatric pain: a systematic review and meta-analysis

Abstract

Pain in pediatric patients represents a significant healthcare challenge, where successful treatment prevents the onset of long-term physical and psychosocial consequences. A multimodal approach has been shown to improve pain control by addressing all pain aspects. To determine the effectiveness of Cognitive-Behavioral Therapy (CBT) in pain management, a systematic review and meta-analysis were conducted following the PRISMA guidelines, which included studies published between 2014 and 2024 in four databases (PubMed, EMBASE, SciELO, Cochrane) and gray literature from Google Scholar. Randomized controlled trials (RCTs) comparing CBT with traditional controls (psychoeducation, waiting list, or placebo), focusing on pain intensity reduction, were considered. Nine studies were eligible after evaluating 2,964 references and applying selection criteria. The meta-analysis showed a moderate effect size (SMD = 0.77; 95% CI: 0.44–1.11) with high heterogeneity (I. > 80%). A substantial benefit was observed in juvenile idiopathic arthritis, and moderate effects were observed in headache/migraine and functional abdominal pain, with no significant differences for chronic pain and fibromyalgia. We conclude that, although CBT is promising, the methodological heterogeneity and asymmetry highlighted by the Egger test warrant caution. Larger, more standardized trials are needed to robustly confirm these findings.