183: Does CBT?I reduce pain interference in chronic pain? A meta?analysis across pain phenotypes

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

Background and Aims: Insomnia and chronic pain frequently co‑occur and represent growing treatment priorities in an ageing population [1]. Disrupted sleep may amplify central sensitisation and weaken descending inhibitory control to worsen mood [2] and pain‑related impairment in daily functioning, known as pain interference [3]. Cognitive Behavioural Therapy for Insomnia (CBT‑I) is the primary online and face-to-face insomnia treatment, increasingly applied to pain management contexts [4-6]; however, its relationship to pain phenotypes remains unclear. We aimed to estimate the pooled effect of CBT‑I on pain interference in adults with chronic pain and potential influences of pain phenotype and delivery mode.

Methods: We conducted a systematic review and meta‑analysis (PROSPERO:CRD42024571478) of randomised controlled trials (RCTs), evaluating CBT-I in adults with chronic non-cancer pain and comorbid insomnia. Databases included MEDLINE, PSYCINFO, CINAHL, alternative literature (Google Scholar, Research Rabbit) and were searched from inception to 1 May 2025. Pain interference was synthesised using random‑effects models (Hedges’ g, negative favours CBT‑I). Prespecified exploratory meta‑regression examined pain phenotype, delivery mode, treatment dose, age, and sex.

Results: Following screening, 19 RCTs met inclusion criteria, with only 8 containing analysable post‑treatment pain interference data (primary outcome). The pooled effect of CBT‑I on pain interference was small with low to very low evidence certainty per GRADE criteria (Hedges' g = −0.249, 95% CI [−0.924, 0.425]). Sensitivity analyses pooling pain interference and severity produced similar effects. Neither Pain type nor delivery mode (e.g. face-to-face, online) appeared to significantly moderate outcomes.

Conclusions: Across a limited and uncertain evidence base, CBT-I showed a small and uncertain impact on pain interference. Whether CBT-I differentially modulates pain-related functioning across chronic pain subtypes could not be determined given power constraints. Future adequately powered, phenotype-specific trials using harmonised outcome measures and patient-informed adaptations are needed to delineate dose-response relationships, clarify underlying mechanisms, and inform precision of delivery of CBT-I for chronic pain populations.

References: [1] Ambrosi CB, Ambrosi PB. Chronic Pain in Elderly: Emerging Challenges and Updates about Line of Care and Pathways. doi:10.5772/intechopen.1010202

[2] Herrero Babiloni A, De Koninck BP, Beetz G, De Beaumont L, Martel MO, Lavigne GJ. Sleep and pain: recent insights, mechanisms, and future directions in the investigation of this relationship. Journal of Neural Transmission. 2020 Apr;127(4):647-60.

[3] Aaron RV, Ravyts SG, Carnahan ND, et al. Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2025;8(3):e250268. doi:10.1001/jamanetworkopen.2025.0268

[4] Enomoto K, Adachi T, Fujino H, Kugo M, Tatsumi S, Sasaki J. Comparison of the effectiveness of cognitive behavioral therapy for insomnia, cognitive behavioral therapy for pain, and hybrid cognitive behavioral therapy for insomnia and pain in individuals with comorbid insomnia and chronic pain: A systematic review and network meta-analysis. Sleep Medicine Reviews. 2022 Dec 1;66:101693.

[5] Malfliet A, Bilterys T, Van Looveren E, Meeus M, Danneels L, Ickmans K, Cagnie B, Mairesse O, Neu D, Moens M, Goubert D. The added value of cognitive behavioral therapy for insomnia to current best evidence physical therapy for chronic spinal pain: protocol of a randomized controlled clinical trial. Brazilian Journal of Physical Therapy. 2019 Jan 1;23(1):62-70.

[6] Klyne DM, Smith SS, Hall M. Should cognitive behavioral therapy for insomnia be considered for preventing and managing chronic pain?. Sleep. 2024 Oct;47(10):zsae177.

Presenting Author: Anastasia Serafimovska
Submitting Author: Anastasia Serafimovska

Senior Author: Professor Sharon Naismith & Dr. Anastasia Suraev

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Anastasia Serafimovska: MClinPsy GDPA BS - Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia; The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
• Andrew Baillie: PhD MClinPsyc BS - Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, NSW, Australia; Sydney Local Health District, NSW, Australia
• Yuki Furukawa - Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany; German Centre for Mental Health (DZPG) partner site, Munich-Augsburg, Germany; Department of Neuropsychiatry, University of Tokyo, Tokyo, Japan
• Sharon Naismith: PhD MNeuroPsych BPsyc - Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia ; The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
• Anastasia Suraev - Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia; The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia