225: Conversational Agents for Pain Management: An Updated Scoping Review

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Non-pharmacological treatments, Digital Health Technologies , Treatment/management

Background and Aims: Pain is a leading cause of healthcare consultations and disability worldwide, with chronic pain often involving psychological and social burden and limited access to effective care [1]. Digital health solutions have been proposed to improve access and delivery of cost-effective interventions [2]. Conversational agents (CAs), powered by artificial intelligence, are emerging tools for supporting patients through emotional support, information gathering, reminders, and behaviour change. While evidence suggests benefits of CAs in mental health, their effectiveness in pain management remain underexplored [3,4]. This scoping review aims to evaluate the applications and effectiveness of CAs to support pain management in adults.

Methods: This update builds on a previous scoping review including studies involving adults (≥18) experiencing or at risk of pain. Eligible interventions were CAs designed to support pain management, including assessment, education, prevention, or treatment. All study designs from the original review were retained. For this update, we searched PubMed, Embase, and ACM Digital Library to identify randomised controlled trials (RCTs) published between January 2025 and April 2026. Two reviewers independently screened records using Covidence. Data extraction was conducted by at least two independent reviewers. Risk of bias in RCTs was assessed using the Cochrane RoB2 tool.

Results: A total of 629 records were identified. After screening, 34 studies met inclusion criteria, including six new RCTs (three completed, three ongoing). Across studies, 1,731 participants were included. Risk of bias was assessed in 12 of 24 RCTs, as the remaining were protocols. Eight RCTs evaluated pain intensity: four favored CAs and four showed no effect. Two RCTs assessed pain interference, with no group differences. Psychological outcomes were mixed across five RCTs, with some improvements in depression, anxiety, and stress. One RCT found improved adherence without pain reduction. Four protocols were identified, indicating ongoing research activity.

Conclusions: The use of CAs in pain management is recent and growing, but evidence of their effectiveness remains limited. Most included RCTs lacked preliminary studies and explored heterogeneous conditions, preventing meta-analyses. Future trials should be guided by feasibility studies and users’ experiences to ensure reliable and meaningful applications.

References: 1. Cohen, S. P., L. Vase, and W. M. Hooten. 2021. “Chronic Pain: An Update on Burden, Best Practices, and New Advances.” Lancet 397, no. 10289: 2082–2097. https://doi.org/10.1016/S0140-6736(21)00393-7.
2. WHO. 2018. “Digital Technologies: Shaping the Future of Primary Healthn Care 2018.” [Internet]. World Health Organization. https://www.who.int/docs/default-source/primary-health-care-conference/digital-technologies.pdf.
3. Li, H., R. Zhang, Y.-C. Lee, R. E. Kraut, and D. C. Mohr. 2023. “Systematic Review and Meta-Analysis of AI-Based Conversational Agents for Promoting Mental Health and Well-Being.” NPJ Digital Medicine 6, no. 1: 236. https://doi.org/10.1038/s41746-023-00979-5.
4. Souza, F. L., Bowman, H., Yang, F., Hesam‐Shariati, N., Linke, J., Gilanyi, Y. L., Jones, M. D., Z‐Pinto, R., McAuley, J. H., & Rizzo, R. R. N. 2025. “Conversational Agents to Support Pain Management: A Scoping Review”. European Journal of Pain, 29(5). https://doi.org/10.1002/ejp.70016

Presenting Author: Filipe Luis Souza
Submitting Author: FIlipe Souza

Senior Author: Rodrigo R. N. Rizzo

IASP 2026 Global Year theme of Neuropathic Pain: No

• Filipe Luis Souza: BPsych(Hons) - University of New South Wales (UNSW) & Neuroscience Research Australia (NeuRA)
• Hannah Bowman: MS - Neuroscience Research Australia (NeuRA)
• Francis Yang: BExPhys(Hons) - University of New South Wales (UNSW) & Neuroscience Research Australia (NeuRA)
• Negin Hesam-Shariati: PhD - University of New South Wales (UNSW) & Neuroscience Research Australia (NeuRA)
• Jackson Linke: BExPhys(Hons) - Univeristy of New South Wales (UNSW) & Neuroscience Research Australia (NeuRA)
• Yannick L. Gilanyi: BExPhys(Hons) - Univeristy of New South Wales (UNSW) & Neuroscience Research Australia (NeuRA)
• Matthew D. Jones: PhD - Univeristy of New South Wales (UNSW) & Neuroscience Research Australia (NeuRA)
• Rafael Z. Pinto: PhD - Univeristy of New South Wales (UNSW) & Neuroscience Research Australia (NeuRA)
• James H. McAuley: PhD - University of New South Wales (UNSW) & Neuroscience Research Australia (NeuRA)
• Rodrigo R. N. Rizzo: PhD - University of New South Wales (UNSW) & Neuroscience Research Australia (NeuRA)